MEDICARE: MOUNTAIN VALLEY COUNSELING ASSOCIATES, INC.

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	BH-896	AZ

General Provider Information

NPI Number	:	1891983375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VALLEY COUNSELING ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	2432 W PEORIA AVE
Second Line	:	SUITE 1343
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4726
Country	:	US
Telephone Number	:	602-870-0972
Fax Number	:	602-870-4271

Provider Business Practice Location Address
First Line	:	2432 W PEORIA AVE
Second Line	:	SUITE 1343
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4726
Country	:	US
Telephone Number	:	602-870-0972
Fax Number	:	602-870-4271

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MARCY WILKERSON
Credential	:	CPA
Telephone Number	:	602-870-0972

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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