Provider Demographics
NPI:1609142421
Name:ARIZONA COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:ARIZONA COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:LORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-818-7117
Mailing Address - Street 1:270 E HUNT HWY
Mailing Address - Street 2:SUITE 16, PMB 144
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-4962
Mailing Address - Country:US
Mailing Address - Phone:480-818-7117
Mailing Address - Fax:480-987-9252
Practice Address - Street 1:5418 E SKYLINE DR BLDG 1
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-9000
Practice Address - Country:US
Practice Address - Phone:480-818-7117
Practice Address - Fax:480-987-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-12587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty