Provider Demographics
NPI:1104836634
Name:ARIZONA COUNSELING RESOURCES
Entity Type:Organization
Organization Name:ARIZONA COUNSELING RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BURDETTE
Authorized Official - Middle Name:O
Authorized Official - Last Name:LEIKVOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:623-974-0357
Mailing Address - Street 1:10559 N 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-5413
Mailing Address - Country:US
Mailing Address - Phone:623-974-0357
Mailing Address - Fax:
Practice Address - Street 1:10559 N 99TH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-5413
Practice Address - Country:US
Practice Address - Phone:623-974-0357
Practice Address - Fax:623-974-0399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty