Provider Demographics
NPI:1225632565
Name:PAINTED DESERT COUNSELING
Entity Type:Organization
Organization Name:PAINTED DESERT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:928-503-1827
Mailing Address - Street 1:1310 SMITHSON DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:AZ
Mailing Address - Zip Code:86025-1947
Mailing Address - Country:US
Mailing Address - Phone:928-503-1827
Mailing Address - Fax:
Practice Address - Street 1:1310 SMITHSON DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:AZ
Practice Address - Zip Code:86025-1947
Practice Address - Country:US
Practice Address - Phone:928-503-1827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)