Provider Demographics
NPI:1245998012
Name:FOUNTAIN OF HOPE COUNSELING INC
Entity type:Organization
Organization Name:FOUNTAIN OF HOPE COUNSELING INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-266-1819
Mailing Address - Street 1:2151 S HIGHWAY 92 STE 104
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5283
Mailing Address - Country:US
Mailing Address - Phone:520-266-1819
Mailing Address - Fax:
Practice Address - Street 1:2151 S HIGHWAY 92 STE 104
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5283
Practice Address - Country:US
Practice Address - Phone:520-266-1819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1790438760Medicaid