Provider Demographics
NPI:1922542174
Name:STATT COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:STATT COUNSELING SERVICES, PLLC
Other - Org Name:AFFINITY COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STATT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:520-257-1168
Mailing Address - Street 1:PO BOX 89784
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85752-9784
Mailing Address - Country:US
Mailing Address - Phone:520-257-1168
Mailing Address - Fax:520-306-4861
Practice Address - Street 1:3295 W INA RD STE 125
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2195
Practice Address - Country:US
Practice Address - Phone:520-257-1168
Practice Address - Fax:520-306-4861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty