=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912187675
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE COPING CONSULTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2007
-----------------------------------------------------
Last Update Date | 11/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4143 N 10TH ST
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85014-4731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-274-3492
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4143 N 10TH ST
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85014-4731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-274-3492
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST/SUPERVISOR
-----------------------------------------------------
Name | JOHN B. MCGAREY M.A.
-----------------------------------------------------
Credential | LPC, M.A.
-----------------------------------------------------
Telephone | 602-274-3492
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC-1066
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------