Individual
VAN EDEN CAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MC, LPC
Contact information
Practice address
7075 W BELL RD, SUITE 3, GLENDALE, AZ 85308-8546
(602) 485-1245
(623) 878-0233
Mailing address
20165 N 67TH AVE, SUITE 122A PMB 144, GLENDALE, AZ 85308-7002
(602) 485-1245
(623) 878-0233
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-2363
AZ
Other
Enumeration date
11/15/2006
Last updated
07/08/2007
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