Provider Demographics
NPI:1215705579
Name:UNSHACKLED MINDS COUNSELING PLLC
Entity type:Organization
Organization Name:UNSHACKLED MINDS COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:ZONOBIA
Authorized Official - Last Name:VARNER-ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LAMFT
Authorized Official - Phone:602-345-1795
Mailing Address - Street 1:13271 W SMOKI CT UNIT A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85307-3267
Mailing Address - Country:US
Mailing Address - Phone:912-224-4427
Mailing Address - Fax:
Practice Address - Street 1:13271 W SMOKI CT UNIT A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85307-3267
Practice Address - Country:US
Practice Address - Phone:026-345-1795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health