Provider Demographics
NPI:1235441460
Name:Q COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:Q COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-570-2373
Mailing Address - Street 1:2030 N DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2123
Mailing Address - Country:US
Mailing Address - Phone:602-570-2373
Mailing Address - Fax:
Practice Address - Street 1:301 E BETHANY HOME RD
Practice Address - Street 2:STE C-296
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1263
Practice Address - Country:US
Practice Address - Phone:602-570-2373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-02
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW127421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11984370OtherCAQH
AZ432878Medicaid
AZ432878Medicaid