Provider Demographics
NPI:1063600542
Name:MOUNTAIN VALLEY COUNSELING ASSOCIATES, INC.
Entity type:Organization
Organization Name:MOUNTAIN VALLEY COUNSELING ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:480-962-7808
Mailing Address - Street 1:145 E UNIVERSITY DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-5945
Mailing Address - Country:US
Mailing Address - Phone:480-962-7808
Mailing Address - Fax:480-962-0560
Practice Address - Street 1:145 E UNIVERSITY DR
Practice Address - Street 2:SUITE 6
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5945
Practice Address - Country:US
Practice Address - Phone:480-962-7808
Practice Address - Fax:480-962-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-1852251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health