Provider Demographics
NPI:1538271630
Name:COUNSELING COVENANT, LLC
Entity type:Organization
Organization Name:COUNSELING COVENANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:RITLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-810-0933
Mailing Address - Street 1:2550 E ROSE GARDEN LN #71155
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-7707
Mailing Address - Country:US
Mailing Address - Phone:602-810-0933
Mailing Address - Fax:623-266-7030
Practice Address - Street 1:15152 N FRANK LLOYD WRIGHT BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2869
Practice Address - Country:US
Practice Address - Phone:602-810-0933
Practice Address - Fax:623-266-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ110871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty