Provider Demographics
NPI:1265974943
Name:AZ FAMILY LIFE COUNSELING COACHING
Entity type:Organization
Organization Name:AZ FAMILY LIFE COUNSELING COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-316-9899
Mailing Address - Street 1:34406 N 27TH DR
Mailing Address - Street 2:BUILDING 6, SUITE 140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6082
Mailing Address - Country:US
Mailing Address - Phone:480-535-5028
Mailing Address - Fax:480-535-5028
Practice Address - Street 1:34406 N 27TH DR
Practice Address - Street 2:BUILDING 6, SUITE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6082
Practice Address - Country:US
Practice Address - Phone:480-535-5028
Practice Address - Fax:480-535-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15944101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty