Provider Demographics
NPI:1326240243
Name:PSYCHOLOGICAL COUNSELING SERVICES
Entity Type:Organization
Organization Name:PSYCHOLOGICAL COUNSELING SERVICES
Other - Org Name:PSYCHOLOGICAL COUNSELING SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:EARLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-947-5739
Mailing Address - Street 1:7530 E ANGUS DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6410
Mailing Address - Country:US
Mailing Address - Phone:480-947-5379
Mailing Address - Fax:
Practice Address - Street 1:14815 E LOOKOUT LEDGE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6408
Practice Address - Country:US
Practice Address - Phone:480-236-6682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10982251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ10915OtherLISAC
AZ10982OtherLPC