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NPI Code Detail

MEDICARE: EXTINGUISHING FEAR LIFE COACHING

MEDICARE: EXTINGUISHING FEAR LIFE COACHING
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1851934012
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXTINGUISHING FEAR LIFE COACHING
Provider Business Mailing Address
First Line : 4435 E CHANDLER BLVD
Second Line :
City : PHOENIX
State : AZ
Zip : 85048-7649
Country : US
Telephone Number : 203-609-1714
Fax Number :
Provider Business Practice Location Address
First Line : 4435 E CHANDLER BLVD
Second Line :
City : PHOENIX
State : AZ
Zip : 85048-7649
Country : US
Telephone Number : 203-609-1714
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DEJAYE BOTKIN
Credential : LPC
Telephone Number : 203-609-1714
Provider Enumeration Date : 10/21/2019
Last Update Date : 10/21/2019

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Directions to “EXTINGUISHING FEAR LIFE COACHING ” Practice Location

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