NPIMap

Organization Active NPI

Lifeline Professional Counseling Services, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chandler, AZ
National Provider Identifier
1285823377
Registry record updated May 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
OTC6153 Issued in AZ
Legal business name
LIFELINE PROFESSIONAL COUNSELING SERVICES, INC
Practice address
335 N. Alma School Rd
Ste E
Chandler, AZ 85224
Phone
(480) 641-1165
Fax
(480) 641-9026
NPI assigned
Oct 15, 2007
Last updated
May 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2020

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

Authorized official

Name
Dr. Roxanne Daltos, PHD
Title
Pres.
Phone
(480) 641-1165

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X OTC6153 AZ Primary
Counselor 101Y00000X NU

Addresses

Primary practice location

335 N. Alma School Rd
Ste E
Chandler, AZ 85224

Mailing address

335 N. Alma School Rd
Ste E
Chandler, AZ 85224
Phone (480) 641-1165

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200512000147 AZ Part B Supplier - Clinic/Group Practice 8123459914 Receives reassigned benefits from 8 practitioners
Practice locations: Glendale, AZ; Tempe, AZ; Scottsdale, AZ; Mesa, AZ; Chandler, AZ; Avondale, AZ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2141191Lifeline Professional Counseling Services335 N Alma School Rd, Suite E, Chandler, AZ 85224Certificate of waiverDec 7, 2027

National Provider Directory

National Provider Directory
Tax ID family
Lifeline Professional Counseling Services Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10320 W McDowell Rd
Ste F7022
Avondale, AZ 85392
Phone 48064111654

10320 W McDowell Rd
Ste G7022
Avondale, AZ 85392
Phone 4806411165 ext. 5

17235 N 75th Ave
Ste F100
Glendale, AZ 85308
Phone 4806411165 ext. 3

1423 S Higley Rd
Ste 103
Mesa, AZ 85206
Phone (480) 369-1870

Practitioners & affiliated clinicians

Practitioners 51

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590537600000",
    "number": "1285823377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 N. ALMA SCHOOL RD",
            "address_2": "STE E",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "85224",
            "telephone_number": "480-641-1165",
            "fax_number": "480-641-9026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 N. ALMA SCHOOL RD",
            "address_2": "STE E",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "85224",
            "telephone_number": "480-641-1165",
            "fax_number": "480-641-9026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELINE PROFESSIONAL COUNSELING SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-15",
        "last_updated": "2020-05-27",
        "certification_date": "2020-05-27",
        "status": "A",
        "authorized_official_last_name": "DALTOS",
        "authorized_official_first_name": "ROXANNE",
        "authorized_official_title_or_position": "PRES.",
        "authorized_official_telephone_number": "480-641-1165",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "AZ",
            "license": "OTC6153",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.