Provider Demographics
NPI:1073762282
Name:C&C THERAPEUTIC SERVICES, INC.
Entity Type:Organization
Organization Name:C&C THERAPEUTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:602-866-0230
Mailing Address - Street 1:11024 N 28TH DR
Mailing Address - Street 2:STE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4377
Mailing Address - Country:US
Mailing Address - Phone:602-866-0230
Mailing Address - Fax:602-374-4191
Practice Address - Street 1:11024 N 28TH DR
Practice Address - Street 2:STE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4377
Practice Address - Country:US
Practice Address - Phone:602-866-0230
Practice Address - Fax:602-374-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC0502101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty