Provider Demographics
NPI:1740802651
Name:IGNITE COUNSELING AND EQUINE PSYCHOTHERAPY
Entity Type:Organization
Organization Name:IGNITE COUNSELING AND EQUINE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:480-271-5129
Mailing Address - Street 1:4314 E ROSEMONTE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3346
Mailing Address - Country:US
Mailing Address - Phone:480-271-5129
Mailing Address - Fax:
Practice Address - Street 1:28475 N 84TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-2265
Practice Address - Country:US
Practice Address - Phone:480-271-5129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)