Gathered Connections Counseling Professional Limited Liability Com
Organization Active NPI Clinical Social Worker · Glendale, AZ
NPI 1851004584 · NPPES record last updated Jun 7, 2023
Key facts
- NPI
- 1851004584
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- GATHERED CONNECTIONS COUNSELING PROFESSIONAL LIMITED LIABILITY COM
- Practice address
- 17505 N 79TH Ave Ste 304C
Glendale, AZ 85308-8729 - Phone
- (623) 521-5096
- NPI assigned
- Dec 27, 2022
- Organization subpart
- No
Authorized official
- Name
- Michele Wiest, LCSW
- Title
- Owner
- Phone
- (623) 521-5096
Practitioners 5
-
Sarah Ellen Kircher, LMSW
-
Jennifer Jenine Ramos, LCSW
-
Karen L Tabloff, LCSW
-
Margarita Madrid, PMHNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230726001632 | AZ | Part B Supplier - Clinic/Group Practice | 7911368709 |
Receives reassigned benefits from 3 practitioners Practice locations: Goodyear, AZ; Surprise, AZ |
National Provider Directory
Locations
17505 N 79th Ave
Ste 304C
Glendale, AZ 85308
Phone (602) 584-5859
1360 N Bullard Ave
Ste 206
Goodyear, AZ 85395
Phone (623) 201-0719
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | Yes |
Addresses
Primary practice location
17505 N 79TH Ave Ste 304C
Glendale, AZ 85308-8729
Mailing address
30175 W Mulberry Dr
Buckeye, AZ 85396-3158
Phone (623) 521-5096
Other providers in Glendale, AZ
- Lisa Garza
- Liyouwork Gashi
- Nieshia Renee Gaskins
- Gateway Behavioral Health LLC
- Kayce Gatewood
- Shelby Marie Gattis
- Maren Gavia
- Anette G Gawelko
- Gary E Gawelko Sr.
- Andrea Kay Gearing
All providers in Glendale, AZ · Clinical Social Worker in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.