Provider Demographics
NPI:1962651596
Name:THERAPEUTIC CONSULTING SERVICES
Entity Type:Organization
Organization Name:THERAPEUTIC CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-258-2915
Mailing Address - Street 1:PO BOX 1598
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-1598
Mailing Address - Country:US
Mailing Address - Phone:480-258-2915
Mailing Address - Fax:480-888-0231
Practice Address - Street 1:22717 S ELLSWORTH RD
Practice Address - Street 2:B-101
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-6127
Practice Address - Country:US
Practice Address - Phone:480-258-2915
Practice Address - Fax:480-888-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-2854104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z122647OtherMEDICARE PTAN
AZ752586Medicaid
Z122648OtherMEDICARE PTAN