Provider Demographics
NPI:1104598812
Name:COUNSEL CONNECT PLLC
Entity type:Organization
Organization Name:COUNSEL CONNECT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHABATKA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:415-840-6822
Mailing Address - Street 1:21397 N 71ST DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9552
Mailing Address - Country:US
Mailing Address - Phone:415-840-6822
Mailing Address - Fax:
Practice Address - Street 1:17100 N 67TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3698
Practice Address - Country:US
Practice Address - Phone:415-840-6822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA