Provider Demographics
NPI:1720313687
Name:DEER VALLEY COUNSELING
Entity Type:Organization
Organization Name:DEER VALLEY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LANGLEY
Authorized Official - Last Name:NETTLES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:602-750-8051
Mailing Address - Street 1:2301 W DUNLAP AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2844
Mailing Address - Country:US
Mailing Address - Phone:602-750-8051
Mailing Address - Fax:602-674-5701
Practice Address - Street 1:2301 W DUNLAP AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2844
Practice Address - Country:US
Practice Address - Phone:602-750-8051
Practice Address - Fax:602-674-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-11
Last Update Date:2009-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-10782101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty