Provider Demographics
NPI:1043460397
Name:SAN TAN COUNSELING LLC
Entity type:Organization
Organization Name:SAN TAN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:D
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-292-3131
Mailing Address - Street 1:288 N IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85220-3830
Mailing Address - Country:US
Mailing Address - Phone:480-982-2356
Mailing Address - Fax:480-982-2449
Practice Address - Street 1:288 N IRONWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-3830
Practice Address - Country:US
Practice Address - Phone:480-982-2356
Practice Address - Fax:480-982-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty