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General NPI Number Information
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NPI Number | 1982942553
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Entity Type | Organization
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Legal Business Name | CIRCLE MOUNTAIN COUNSELING, LLC
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 18789 N REEMS RD STE 260
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City | SURPRISE
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State | AZ
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Zip | 85374-8648
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Country | US
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Telephone | 623-432-0668
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Fax |
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Provider Business Mailing Address
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Address Line | 18789 N REEMS RD STE 260
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City | SURPRISE
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State | AZ
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Zip | 85374-8648
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Country | US
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Telephone | 623-432-0668
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Fax |
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Authorized Official
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Title or Position | COUNSELOR CO-OWNER
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Name | MRS. APRIL ELISE LAIN
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Credential | LISAC
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Telephone | 623-210-5951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC10221
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC1250
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-10557
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License Number State | AZ
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