Provider Demographics
NPI:1346875986
Name:INTERCEPTION COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:INTERCEPTION COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WASHINGTON
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:520-261-0608
Mailing Address - Street 1:5555 S WHITE SPAR TRL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-0012
Mailing Address - Country:US
Mailing Address - Phone:520-429-6129
Mailing Address - Fax:
Practice Address - Street 1:40 N SWAN RD STE 114
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3019
Practice Address - Country:US
Practice Address - Phone:520-261-0608
Practice Address - Fax:520-422-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health