1396884193 NPI number — ADOBE BEHAVIORAL COUNSELING SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396884193 NPI number — ADOBE BEHAVIORAL COUNSELING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADOBE BEHAVIORAL COUNSELING SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396884193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8727 S PRIEST DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85284-1915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-838-7273
Provider Business Mailing Address Fax Number:
484-704-0083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8727 S PRIEST DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85284-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-838-7273
Provider Business Practice Location Address Fax Number:
480-838-7273
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HANIAN BAILY
Authorized Official First Name:
GWENDOLYN
Authorized Official Middle Name:
FAYE
Authorized Official Title or Position:
SOLE PROPRIETOR OWNER
Authorized Official Telephone Number:
480-838-7273

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC0511 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28647 . This is a "NCC" identifier . This identifiers is of the category "OTHER".
  • Identifier: LPC0511 . This is a "LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com