MEDICARE: AGAPE COUNSELING SERVICE, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	104100000X	Social Worker
3	106H00000X	Marriage & Family Therapist
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1487328969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE COUNSELING SERVICE, PLLC

Provider Business Mailing Address
First Line	:	1934 E CAMELBACK RD STE 120-172
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4126
Country	:	US
Telephone Number	:	480-822-7383
Fax Number	:

Provider Business Practice Location Address
First Line	:	1934 E CAMELBACK RD STE 120-172
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4126
Country	:	US
Telephone Number	:	480-822-7383
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	SHERRY LEE BORLABI
Credential	:	LPC
Telephone Number	:	480-822-7383

Provider Enumeration Date	:	08/06/2021
Last Update Date	:	08/06/2021

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