Organization Name: | GOODWORKS COUNSELING |
NPI Number: | 1003222076 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LARRY KEVIN WIELAND (CEO) |
Mailing Address: | 2950 S Alma School Rd #11 Mesa |
State: | AZ US |
Postal Code: | 852104036 |
Phone Number: | 4808211330 |
Fax Number: | 4804566134 |
NPI Enumeration Date: | 07/10/2014 |
NPI Last Update Date: | 07/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LAC-14607 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AZ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |