Provider Demographics
NPI:1063743326
Name:CMG COUNSELING PLLC
Entity type:Organization
Organization Name:CMG COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:520-975-2028
Mailing Address - Street 1:10501 E SEVEN GENERATIONS WAY
Mailing Address - Street 2:#121
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5828
Mailing Address - Country:US
Mailing Address - Phone:520-975-2028
Mailing Address - Fax:520-207-0892
Practice Address - Street 1:10501 E SEVEN GENERATIONS WAY
Practice Address - Street 2:#121
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-5828
Practice Address - Country:US
Practice Address - Phone:520-975-2028
Practice Address - Fax:520-207-0892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2013-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-122301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ458095Medicaid
AZZ136303Medicare PIN