Provider Demographics
NPI: | 1821757683 |
---|---|
Name: | CIRCLE OF HEARTS COUNSELING, PLLC |
Entity Type: | Organization |
Organization Name: | CIRCLE OF HEARTS COUNSELING, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/ THERAPIST |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | CONNIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PARKER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW |
Authorized Official - Phone: | 480-232-5437 |
Mailing Address - Street 1: | 3707 E SOUTHERN AVE STE 1028 |
Mailing Address - Street 2: | |
Mailing Address - City: | MESA |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85206-6202 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-442-6081 |
Mailing Address - Fax: | 480-781-4670 |
Practice Address - Street 1: | 3707 E SOUTHERN AVE STE 1028 |
Practice Address - Street 2: | |
Practice Address - City: | MESA |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85206-6202 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-442-6081 |
Practice Address - Fax: | 480-781-4670 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-12-09 |
Last Update Date: | 2021-12-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |