Provider Demographics
NPI:1245504927
Name:ALLIANCE COUNSELING CENTER
Entity type:Organization
Organization Name:ALLIANCE COUNSELING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:DBH, LCSW, LISAC
Authorized Official - Phone:520-281-0009
Mailing Address - Street 1:1790 N MASTICK WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-1135
Mailing Address - Country:US
Mailing Address - Phone:520-281-0009
Mailing Address - Fax:520-281-0009
Practice Address - Street 1:1790 N MASTICK WAY
Practice Address - Street 2:SUITE A
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-1135
Practice Address - Country:US
Practice Address - Phone:520-281-0009
Practice Address - Fax:520-281-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC10240101YA0400X
AZLPC11949101YP2500X
AZLCSW130601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty