Provider Demographics
NPI:1205044526
Name:HART, MC, LPC, ILENE (MC, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:
Last Name:HART, MC, LPC
Suffix:
Gender:F
Credentials:MC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 N SECOND ST
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-1708
Mailing Address - Country:US
Mailing Address - Phone:800-550-3922
Mailing Address - Fax:
Practice Address - Street 1:256 N SECOND ST
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-1708
Practice Address - Country:US
Practice Address - Phone:800-550-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional