| Gathered Connections Counseling Professional Limited Liability Com | |
|
17505 N 79th Ave Ste 304c Glendale AZ 85308-8729 | |
| (623) 521-5096 | |
| Not Available |
| Full Name | Gathered Connections Counseling Professional Limited Liability Com |
|---|---|
| Speciality | Social Worker |
| Location | 17505 N 79th Ave Ste 304c, Glendale, Arizona |
| Authorized Official Name and Position | Michele Wiest (OWNER) |
| Authorized Official Contact | 6235215096 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gathered Connections Counseling Professional Limited Liability Com 30175 W Mulberry Dr Buckeye AZ 85396-3158 Ph: (623) 521-5096 | Gathered Connections Counseling Professional Limited Liability Com 17505 N 79th Ave Ste 304c Glendale AZ 85308-8729 Ph: (623) 521-5096 |
| NPI Number | 1851004584 |
|---|---|
| Provider Enumeration Date | 12/27/2022 |
| Last Update Date | 06/07/2023 |
| Certification Date | 06/07/2023 |
| Medicare PECOS PAC ID | 7911368709 |
|---|---|
| Medicare Enrollment ID | O20230726001632 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851004584 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Michele Wiest |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700384070 PECOS PAC ID: 1456712256 Enrollment ID: I20230726001971 |
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