Provider Demographics
NPI:1730504796
Name:DESERT EAGLE COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:DESERT EAGLE COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:480-269-1733
Mailing Address - Street 1:1835 W CHANDLER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5286
Mailing Address - Country:US
Mailing Address - Phone:480-269-1733
Mailing Address - Fax:
Practice Address - Street 1:1835 W CHANDLER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5286
Practice Address - Country:US
Practice Address - Phone:480-269-1733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-13746251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare