Provider Demographics
NPI:1134436348
Name:DEER VALLEY COUNSELING, INC.
Entity type:Organization
Organization Name:DEER VALLEY COUNSELING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:NETTLES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:602-750-8705
Mailing Address - Street 1:2301 W DUNLAP AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2844
Mailing Address - Country:US
Mailing Address - Phone:602-750-8705
Mailing Address - Fax:
Practice Address - Street 1:2301 W DUNLAP AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2844
Practice Address - Country:US
Practice Address - Phone:602-750-8705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11594101YP2500X
AZLPC-13346101YP2500X
AZLCSW-107821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty