Provider Demographics
NPI:1508308776
Name:ARIZONA BLUE SKY COUNSELING, LLC
Entity Type:Organization
Organization Name:ARIZONA BLUE SKY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC, LPC
Authorized Official - Phone:623-252-2737
Mailing Address - Street 1:PO BOX 73156
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-1036
Mailing Address - Country:US
Mailing Address - Phone:623-252-2737
Mailing Address - Fax:623-258-4077
Practice Address - Street 1:2060 W WHISPERING WIND DR
Practice Address - Street 2:#264
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-2867
Practice Address - Country:US
Practice Address - Phone:623-252-2737
Practice Address - Fax:623-258-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-14261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty