Provider Demographics
NPI:1245902345
Name:SACRED CANYON COUNSELING LLC
Entity type:Organization
Organization Name:SACRED CANYON COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VAN SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:928-662-9978
Mailing Address - Street 1:PO BOX 21113
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86341-1113
Mailing Address - Country:US
Mailing Address - Phone:928-662-9978
Mailing Address - Fax:
Practice Address - Street 1:7000, 2 AZ-179 D200
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-9270
Practice Address - Country:US
Practice Address - Phone:928-662-9978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty