Provider Demographics
NPI:1689458515
Name:INTENTIONAL LIFE COUNSELING
Entity Type:Organization
Organization Name:INTENTIONAL LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:R ALANA
Authorized Official - Last Name:INEMER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-781-8202
Mailing Address - Street 1:7560 S WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5004
Mailing Address - Country:US
Mailing Address - Phone:602-781-8202
Mailing Address - Fax:
Practice Address - Street 1:7360 S WILLOW DRIVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85484
Practice Address - Country:US
Practice Address - Phone:602-730-4628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty