Provider Demographics
NPI:1649341926
Name:ALTERNATIVES COUNSELING SERVICE, INC.
Entity type:Organization
Organization Name:ALTERNATIVES COUNSELING SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT, EXEC. DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGG
Authorized Official - Middle Name:
Authorized Official - Last Name:DERROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-459-1148
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:DRAGOON
Mailing Address - State:AZ
Mailing Address - Zip Code:85609-0162
Mailing Address - Country:US
Mailing Address - Phone:520-459-1148
Mailing Address - Fax:520-586-0171
Practice Address - Street 1:999 E FRY BLVD
Practice Address - Street 2:#305
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2616
Practice Address - Country:US
Practice Address - Phone:520-459-1148
Practice Address - Fax:520-459-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-2641251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ094421OtherAHCCCS