Provider Demographics
NPI:1043098650
Name:MESA VERDE COUNSELING INC
Entity Type:Organization
Organization Name:MESA VERDE COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ASA
Authorized Official - Middle Name:
Authorized Official - Last Name:RHINEHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-435-9027
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-1300
Mailing Address - Country:US
Mailing Address - Phone:520-435-9025
Mailing Address - Fax:
Practice Address - Street 1:174 S CORONADO DR STE B
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-6356
Practice Address - Country:US
Practice Address - Phone:520-435-9027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)