Basic Information
| Provider Information | |||||||||
| NPI: | 1205353083 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AFFINITY COUNSELING CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 89784 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857529784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204477440 | ||||||||
| FaxNumber: | 5203064861 | ||||||||
| Practice Location | |||||||||
| Address1: | 2292 W MAGEE RD STE 260 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857424304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204477440 | ||||||||
| FaxNumber: | 5203064861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2017 | ||||||||
| LastUpdateDate: | 08/23/2017 | ||||||||
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| AuthorizedOfficialLastName: | STATT | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5204477440 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 10409 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.