Provider Demographics
NPI:1124342993
Name:MENDING HEARTS FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:MENDING HEARTS FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, M ED, LPC
Authorized Official - Phone:602-633-2246
Mailing Address - Street 1:17431 N. 71ST DR.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:602-633-2246
Mailing Address - Fax:602-687-7069
Practice Address - Street 1:17431 N. 71ST DR.
Practice Address - Street 2:SUITE 103
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:602-633-2246
Practice Address - Fax:602-687-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC - 1003251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-1003OtherLICENSED PROFESSIONAL COUNSELOR
S1642OtherREGISTERED PLAY THERAPY SUPERVISOR
AZ649014OtherAHCCCS