Provider Demographics
NPI:1447096235
Name:KOKORO TRANSITIONAL RECOVERY AND COUNSELING SERVICES
Entity type:Organization
Organization Name:KOKORO TRANSITIONAL RECOVERY AND COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,LISAC
Authorized Official - Phone:602-793-7609
Mailing Address - Street 1:575 S 143RD AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-3005
Mailing Address - Country:US
Mailing Address - Phone:602-793-7609
Mailing Address - Fax:
Practice Address - Street 1:575 S 143RD AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-3005
Practice Address - Country:US
Practice Address - Phone:602-793-7609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty