Provider Demographics
NPI:1275383184
Name:TRAILHEADS COUNSELING AND CONSULTING SERVICES OF THE SOUTHWEST
Entity Type:Organization
Organization Name:TRAILHEADS COUNSELING AND CONSULTING SERVICES OF THE SOUTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:623-282-2751
Mailing Address - Street 1:22 W HARMONT DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5638
Mailing Address - Country:US
Mailing Address - Phone:623-282-2751
Mailing Address - Fax:
Practice Address - Street 1:2525 E ARIZONA BILTMORE CIR STE B220
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-2133
Practice Address - Country:US
Practice Address - Phone:623-282-2751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty