Provider Demographics
NPI:1578803003
Name:IMAGE COUNSELING SERVICES
Entity Type:Organization
Organization Name:IMAGE COUNSELING SERVICES
Other - Org Name:IMAGE COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:H
Authorized Official - Last Name:NEESE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:602-292-5524
Mailing Address - Street 1:1616 N LITCHFIELD RD
Mailing Address - Street 2:240
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1252
Mailing Address - Country:US
Mailing Address - Phone:602-292-5524
Mailing Address - Fax:623-877-0301
Practice Address - Street 1:1616 N LITCHFIELD RD
Practice Address - Street 2:240
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1252
Practice Address - Country:US
Practice Address - Phone:602-292-5524
Practice Address - Fax:623-877-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT - 10190251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health