Provider Demographics
NPI:1902045024
Name:SONORAN CONCEPTS, LLC
Entity Type:Organization
Organization Name:SONORAN CONCEPTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:NCC,CACII,LPC
Authorized Official - Phone:843-446-0541
Mailing Address - Street 1:1304 AZALEA CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577
Mailing Address - Country:US
Mailing Address - Phone:843-446-0541
Mailing Address - Fax:
Practice Address - Street 1:1304 AZALEA CT
Practice Address - Street 2:SUITE C
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577
Practice Address - Country:US
Practice Address - Phone:843-446-0541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health