Provider Demographics
NPI:1316609142
Name:ARIZONA COUNSELING COLLECTIVE,LLC
Entity type:Organization
Organization Name:ARIZONA COUNSELING COLLECTIVE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-200-6373
Mailing Address - Street 1:2150 S COUNTRY CLUB DR STE 34
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6885
Mailing Address - Country:US
Mailing Address - Phone:480-662-6708
Mailing Address - Fax:602-357-4550
Practice Address - Street 1:2150 S COUNTRY CLUB DR STE 34
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6885
Practice Address - Country:US
Practice Address - Phone:480-662-6708
Practice Address - Fax:602-357-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health