Provider Demographics
NPI:1881134948
Name:BELLA ROSA COUNSELING AND CONSULTATION SERVICES, LLC
Entity type:Organization
Organization Name:BELLA ROSA COUNSELING AND CONSULTATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIZABETH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:480-241-7805
Mailing Address - Street 1:PO BOX 1986
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-1986
Mailing Address - Country:US
Mailing Address - Phone:480-241-7805
Mailing Address - Fax:
Practice Address - Street 1:3048 E BASELINE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7286
Practice Address - Country:US
Practice Address - Phone:480-241-7805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16518101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty