Provider Demographics
NPI:1104459809
Name:PRISM COUNSELING LLC
Entity type:Organization
Organization Name:PRISM COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TRES
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:ADAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV, BCPC
Authorized Official - Phone:480-525-7284
Mailing Address - Street 1:9299 W OLIVE AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8382
Mailing Address - Country:US
Mailing Address - Phone:480-525-7284
Mailing Address - Fax:
Practice Address - Street 1:9299 W OLIVE AVE STE 212
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8382
Practice Address - Country:US
Practice Address - Phone:480-525-7284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty