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General NPI Number Information
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NPI Number | 1972326973
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Entity Type | Organization
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Legal Business Name | DK COUNSELING AND CLINICAL SUPERVISION, LLC
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 8765 W KELTON LN BLDG B3
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City | PEORIA
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State | AZ
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Zip | 85382-3584
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Country | US
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Telephone | 602-613-0403
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Fax |
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Provider Business Mailing Address
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Address Line | 17421 N 85TH DR
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City | PEORIA
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State | AZ
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Zip | 85382-8026
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Country | US
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Telephone | 602-613-0403
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. DANIEL KAPELLE
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Credential | LCSW
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Telephone | 602-613-0403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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