Organization
DIRECT CONNECT VENTURES LLC
Active
Other names
Desert Foothills Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IVORY KAIMARON PRICE (CEO)
(520) 371-3782
Entity
Organization
Contact information
Practice address
1760 E VILLA DR STE A, COTTONWOOD, AZ 86326-4679
(520) 371-3782
Mailing address
26 E BASELINE RD, SUITE 132, PHOENIX, AZ 85042-6951
(602) 362-5100
(928) 646-7153
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
OTC6593
AZ
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
385H00000X
Respite Care
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548741812
—
AZ
05
—
1649939539
—
AZ
Enumeration date
11/24/2015
Last updated
03/08/2022
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