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NPI Code Detail

MEDICARE: COPIHUE COUNSELING, LLC

MEDICARE: COPIHUE COUNSELING, LLC
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1184392409
Entity Type Code : Organization
Provider Name (Legal Business Name) : COPIHUE COUNSELING, LLC
Provider Business Mailing Address
First Line : 2806 N ALVERNON WAY STE 500
Second Line :
City : TUCSON
State : AZ
Zip : 85712-1567
Country : US
Telephone Number : 520-955-8351
Fax Number :
Provider Business Practice Location Address
First Line : 2806 N ALVERNON WAY STE 500
Second Line :
City : TUCSON
State : AZ
Zip : 85712-1567
Country : US
Telephone Number : 520-955-8351
Fax Number :
Authorized Official
Title or Position : OWNER, CLINICAL THERAPIST
Name : AMY WILKERSON
Credential : LCSW
Telephone Number : 414-426-6285
Provider Enumeration Date : 09/01/2021
Last Update Date : 09/01/2021

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