Immanuel Behavioral Health Counseling Clinic

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

IMMANUEL BEHAVIORAL HEALTH COUNSELING CLINIC

Practice address

11301 N 99TH Ave Ste 5120
Peoria, AZ 85345-5485

Phone

(623) 876-6379

Fax

(623) 876-6379

NPI assigned

Jun 23, 2021

Organization subpart

Yes

Parent organization

15856As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brenda Kay Pierce, MD MA

Title

Chief Operating Officer

Phone

(623) 738-8549

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Immanuel Behavioral Health Counseling Clinic

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Aliece Pierce-Anderson, LPC

  • Professional Counselor
  • Phoenix, AZ
  • NPI 1639002264
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682553600000",
    "number": "1104495084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11301 N 99TH AVE STE 5120",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853455485",
            "telephone_number": "623-876-6379",
            "fax_number": "623-876-6379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11301 N 99TH AVE STE 5120",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853455485",
            "telephone_number": "623-876-6379",
            "fax_number": "623-876-6379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMANUEL BEHAVIORAL HEALTH COUNSELING CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "15856",
        "enumeration_date": "2021-06-23",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A",
        "authorized_official_last_name": "PIERCE",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "623-738-8549",
        "authorized_official_credential": "MD MA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "447591",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Marianne Illustre
• Immanuel Caring Ministries, Inc.
• Immune Centered Health
• Impact Health Services LLC
• Impact Physical Therapy LLC
• Anca O Incean

• Clinic/Center in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.