Provider Demographics
NPI:1902577745
Name:SUPREME COUNSEL PLLC
Entity Type:Organization
Organization Name:SUPREME COUNSEL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER- CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DUSE-TIMOTHY
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:602-693-2826
Mailing Address - Street 1:20 E THOMAS RD STE 2200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3133
Mailing Address - Country:US
Mailing Address - Phone:602-693-2826
Mailing Address - Fax:
Practice Address - Street 1:20 E THOMAS RD STE 2200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3133
Practice Address - Country:US
Practice Address - Phone:602-693-2826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty