Provider Demographics
NPI:1386957645
Name:SUPERSTITION SPRINGS COUNSELING SERVICES OF ARIZONA
Entity type:Organization
Organization Name:SUPERSTITION SPRINGS COUNSELING SERVICES OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVATE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MICHAELLE
Authorized Official - Last Name:HENNESSEY-PEIRCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-617-6595
Mailing Address - Street 1:7254 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 123
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-2786
Mailing Address - Country:US
Mailing Address - Phone:602-617-6595
Mailing Address - Fax:480-324-0747
Practice Address - Street 1:7254 E SOUTHERN AVE
Practice Address - Street 2:SUITE 123
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-2786
Practice Address - Country:US
Practice Address - Phone:602-617-6595
Practice Address - Fax:480-324-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-10373261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health