MEDICARE: REGAL GARDEN 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1720772734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGAL GARDEN COUNSELING

Provider Business Mailing Address
First Line	:	1628 E SOUTHERN AVE STE 9626
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-5782
Country	:	US
Telephone Number	:	480-359-4235
Fax Number	:

Provider Business Practice Location Address
First Line	:	1628 E SOUTHERN AVE STE 9626
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-5782
Country	:	US
Telephone Number	:	480-359-4235
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RIANE J DAWSON
Credential	:	LPC
Telephone Number	:	480-359-4235

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	07/27/2023

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