Provider Demographics
NPI:1720388796
Name:FAMILY CHRISTIAN COUNSELING CENTER OF PHOENIX
Entity Type:Organization
Organization Name:FAMILY CHRISTIAN COUNSELING CENTER OF PHOENIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:PETTITT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-320-7955
Mailing Address - Street 1:14244 N 50TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2868
Mailing Address - Country:US
Mailing Address - Phone:602-320-7955
Mailing Address - Fax:
Practice Address - Street 1:1300 E MISSOURI AVE
Practice Address - Street 2:SUITE B200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2362
Practice Address - Country:US
Practice Address - Phone:602-320-7955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC2089101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty