Provider Demographics
NPI:1528810769
Name:PONDEROSA COUNSELING OF ARIZONA
Entity type:Organization
Organization Name:PONDEROSA COUNSELING OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, RXN
Authorized Official - Phone:303-506-7709
Mailing Address - Street 1:8546 N PEPPERBOX RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-4028
Mailing Address - Country:US
Mailing Address - Phone:303-506-7709
Mailing Address - Fax:928-379-5083
Practice Address - Street 1:240 S MONTEZUMA ST STE 201B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4712
Practice Address - Country:US
Practice Address - Phone:303-506-7709
Practice Address - Fax:928-379-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty