Basic Information
| Provider Information | |||||||||
| NPI: | 1013925296 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARIZONA STATE UNIVERSITY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ASU COUNSELING AND CONSULTATION | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5199 | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796085199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668906390 | ||||||||
| FaxNumber: | 3254378390 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 S FOREST AVE # 334 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852871012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809656147 | ||||||||
| FaxNumber: | 4809653426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ARRENDONDO | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DEPUTY VP/UNIV DEAN STUDENT AFFAIR | ||||||||
| AuthorizedOfficialTelephone: | 4809653346 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 103T00000X | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 1041C0700X | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.