MEDICARE: NORTH PHOENIX COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LPC-13569	AZ

General Provider Information

NPI Number	:	1053603399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH PHOENIX COUNSELING

Provider Business Mailing Address
First Line	:	39506 N DAISY MOUNTAIN DR
Second Line	:	STE 122-160
City	:	PHOENIX
State	:	AZ
Zip	:	85086-1663
Country	:	US
Telephone Number	:	623-738-1290
Fax Number	:	623-242-1588

Provider Business Practice Location Address
First Line	:	34975 N NORTH VALLEY PKWY
Second Line	:	SUITE 152
City	:	PHOENIX
State	:	AZ
Zip	:	85086-4028
Country	:	US
Telephone Number	:	623-738-1290
Fax Number	:	623-242-1588

Authorized Official
Title or Position	:	OWNER
Name	:	CESAR GAMEZ
Credential	:	LPC
Telephone Number	:	623-738-1290

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	05/04/2011

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Directions to “NORTH PHOENIX COUNSELING ” Practice Location

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