Provider Demographics
NPI:1316520323
Name:SOLID GROUND COUNSELING AZ LLC
Entity type:Organization
Organization Name:SOLID GROUND COUNSELING AZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SQUIRES
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-574-5063
Mailing Address - Street 1:90 S KYRENE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4687
Mailing Address - Country:US
Mailing Address - Phone:480-681-1101
Mailing Address - Fax:
Practice Address - Street 1:90 S KYRENE RD STE 4
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-4687
Practice Address - Country:US
Practice Address - Phone:480-681-1101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty