1457349037 NPI number — THUNDERBIRD OASIS COUNSELING INC

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 1457349037 NPI number — THUNDERBIRD OASIS COUNSELING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THUNDERBIRD OASIS COUNSELING INC
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:
1457349037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8253 W THUNDERBIRD RD
Provider Second Line Business Mailing Address:
SUITE103
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85381-4616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-776-9921
Provider Business Mailing Address Fax Number:
623-776-9921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8253 W THUNDERBIRD RD
Provider Second Line Business Practice Location Address:
SUITE103
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85381-4616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-776-9921
Provider Business Practice Location Address Fax Number:
623-776-9921
Provider Enumeration Date:
10/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GRAHAM
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-244-6761

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  NONE , 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)





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