Provider Demographics
NPI:1760979397
Name:MOENKOPI COUNSELING PC
Entity Type:Organization
Organization Name:MOENKOPI COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-817-9780
Mailing Address - Street 1:2177 ALISON ROW
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8306
Mailing Address - Country:US
Mailing Address - Phone:435-817-9780
Mailing Address - Fax:
Practice Address - Street 1:230 N 1680 E STE H2
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2585
Practice Address - Country:US
Practice Address - Phone:435-773-8909
Practice Address - Fax:435-673-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center