Organization
FROM WITHIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES KELLEHER (COUNSELOR)
(602) 321-9536
Entity
Organization
Contact information
Practice address
99 E VIRGINIA AVE, STE 170, PHOENIX, AZ 85004-1195
(602) 321-9536
Mailing address
99 E VIRGINIA AVE, STE 170, PHOENIX, AZ 85004-1195
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-13096
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
928418
—
AZ
Enumeration date
11/29/2012
Last updated
11/29/2012
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