| Prescott Relationship Center, Pllc | |
|
510 E Moeller St Prescott AZ 86301-2612 | |
| (928) 420-8300 | |
| Not Available |
| Full Name | Prescott Relationship Center, Pllc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 510 E Moeller St, Prescott, Arizona |
| Authorized Official Name and Position | Keith A. Cross (OWNER/CLINICAL DIRECTOR) |
| Authorized Official Contact | 9284208300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prescott Relationship Center, Pllc 6371 E Deacon St Prescott Valley AZ 86314-6734 Ph: (928) 273-0027 | Prescott Relationship Center, Pllc 510 E Moeller St Prescott AZ 86301-2612 Ph: (928) 420-8300 |
| NPI Number | 1700365467 |
|---|---|
| Provider Enumeration Date | 08/13/2018 |
| Last Update Date | 12/05/2023 |
| Certification Date | 12/05/2023 |
| Medicare PECOS PAC ID | 4789057951 |
|---|---|
| Medicare Enrollment ID | O20230309000693 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700365467 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Jennifer Diane Gray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770951725 PECOS PAC ID: 4486043486 Enrollment ID: I20230309000767 |
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