Provider Demographics
NPI:1447753876
Name:INTERCESSORY COUNSELING & WELLNESS, PLLC
Entity Type:Organization
Organization Name:INTERCESSORY COUNSELING & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-599-2000
Mailing Address - Street 1:11225 N 28TH DR STE D111
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5630
Mailing Address - Country:US
Mailing Address - Phone:602-599-2000
Mailing Address - Fax:602-599-2009
Practice Address - Street 1:11225 N 28TH DR STE D111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5630
Practice Address - Country:US
Practice Address - Phone:602-599-2000
Practice Address - Fax:602-599-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-15078101YA0400X
AZLPC-17155101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ418298Medicaid