Provider Demographics
NPI:1982942553
Name:CIRCLE MOUNTAIN COUNSELING, LLC
Entity Type:Organization
Organization Name:CIRCLE MOUNTAIN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:LAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LISAC
Authorized Official - Phone:623-210-5951
Mailing Address - Street 1:18789 N REEMS RD STE 260
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8648
Mailing Address - Country:US
Mailing Address - Phone:623-432-0668
Mailing Address - Fax:
Practice Address - Street 1:18789 N REEMS RD STE 260
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8648
Practice Address - Country:US
Practice Address - Phone:623-432-0668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIRCLE MOUNTAIN COUNSELING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC10221101YA0400X
AZLISAC1250101YA0400X
AZLPC-10557101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty