Provider Demographics
NPI:1033356738
Name:PROFESSIONAL COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:928-772-3499
Mailing Address - Street 1:PO BOX 27949
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312-7949
Mailing Address - Country:US
Mailing Address - Phone:928-772-3499
Mailing Address - Fax:928-772-3491
Practice Address - Street 1:8183 E FLORENTINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8454
Practice Address - Country:US
Practice Address - Phone:928-772-3499
Practice Address - Fax:928-772-3491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC0410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty