Provider Demographics
NPI:1902206246
Name:SENIOR COUNSELING SERVICES OF ARIZONA LLC
Entity Type:Organization
Organization Name:SENIOR COUNSELING SERVICES OF ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NESBIT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-745-5552
Mailing Address - Street 1:4111 E VALLEY AUTO DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4609
Mailing Address - Country:US
Mailing Address - Phone:480-745-5552
Mailing Address - Fax:
Practice Address - Street 1:4111 E VALLEY AUTO DR STE 201
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4609
Practice Address - Country:US
Practice Address - Phone:480-745-5552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ130461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty