MEDICARE: JOHN DOOLEY LPC

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	LPC1023	AZ

General Provider Information

NPI Number	:	1447324942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DOOLEY LPC

Provider Business Mailing Address
First Line	:	PO BOX 22206
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-0206
Country	:	US
Telephone Number	:	602-359-0838
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 E LAS PALMARITAS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-3848
Country	:	US
Telephone Number	:	602-359-0838
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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