MEDICARE: STRIDE FORWARD 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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1225636319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRIDE FORWARD COUNSELING LLC

Provider Business Mailing Address
First Line	:	PO BOX 1344
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-1829
Country	:	US
Telephone Number	:	480-207-1742
Fax Number	:

Provider Business Practice Location Address
First Line	:	1166 E WARNER RD STE 101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-3065
Country	:	US
Telephone Number	:	480-207-1742
Fax Number	:

Authorized Official
Title or Position	:	LPC
Name	:	JENNIFER SZABO
Credential	:
Telephone Number	:	480-207-1742

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	04/23/2021

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