Provider Demographics
NPI:1194019174
Name:CASA GRANDE COUNSELING SERVICE
Entity Type:Organization
Organization Name:CASA GRANDE COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CORNELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:520-836-0440
Mailing Address - Street 1:635 E COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2023
Mailing Address - Country:US
Mailing Address - Phone:520-836-0440
Mailing Address - Fax:520-836-0924
Practice Address - Street 1:635 E COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2023
Practice Address - Country:US
Practice Address - Phone:520-836-0440
Practice Address - Fax:520-836-0924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health