Provider Demographics
NPI:1942637996
Name:ENCANTADA COUNSELING SERVICES PLLC.
Entity Type:Organization
Organization Name:ENCANTADA COUNSELING SERVICES PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:R
Authorized Official - Last Name:INIGO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:520-331-7699
Mailing Address - Street 1:2711 N INCAS PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-4730
Mailing Address - Country:US
Mailing Address - Phone:520-331-7699
Mailing Address - Fax:
Practice Address - Street 1:6761 E TANQUE VERDE RD
Practice Address - Street 2:SUITE #5
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5323
Practice Address - Country:US
Practice Address - Phone:520-331-7699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12103101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ284538Medicaid