Provider Demographics
NPI:1457349037
Name:THUNDERBIRD OASIS COUNSELING INC
Entity Type:Organization
Organization Name:THUNDERBIRD OASIS COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:480-244-6761
Mailing Address - Street 1:8253 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE103
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4616
Mailing Address - Country:US
Mailing Address - Phone:623-776-9921
Mailing Address - Fax:623-776-9921
Practice Address - Street 1:8253 W THUNDERBIRD RD
Practice Address - Street 2:SUITE103
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4616
Practice Address - Country:US
Practice Address - Phone:623-776-9921
Practice Address - Fax:623-776-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNONE1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty