Provider Demographics
NPI:1154750529
Name:REAL LIFE COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:REAL LIFE COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, STATUTORY AGENT, FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSAK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:480-748-5006
Mailing Address - Street 1:3573 S 158TH PL
Mailing Address - Street 2:BLDG B
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-2046
Mailing Address - Country:US
Mailing Address - Phone:480-748-5006
Mailing Address - Fax:480-265-4444
Practice Address - Street 1:3573 S 158TH PL
Practice Address - Street 2:BLDG B
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-2046
Practice Address - Country:US
Practice Address - Phone:480-748-5006
Practice Address - Fax:480-265-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-13028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty