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3920 S Rural Rd Ste 112 Tempe AZ 85282-5500 | |
| (602) 502-3806 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 3920 S Rural Rd Ste 112, Tempe, Arizona |
| Authorized Official Name and Position | Allyson Fernstrom (OWNER) |
| Authorized Official Contact | 6025023806 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
10538 E Meseto Ave Mesa AZ 85209-7822 Ph: (602) 502-3806 | 3920 S Rural Rd Ste 112 Tempe AZ 85282-5500 Ph: (602) 502-3806 |
| NPI Number | 1639880917 |
|---|---|
| Provider Enumeration Date | 12/08/2022 |
| Last Update Date | 01/24/2025 |
| Certification Date | 01/24/2025 |
| Medicare PECOS PAC ID | 8224480090 |
|---|---|
| Medicare Enrollment ID | O20240117001778 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639880917 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Linda Rebecca Weiss |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801288576 PECOS PAC ID: 9335590843 Enrollment ID: I20240109004186 |
| Provider Name | Deborah C Kovaleski |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043098460 PECOS PAC ID: 5092167874 Enrollment ID: I20240117001994 |
| Provider Name | Paul K Gibson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1427416387 PECOS PAC ID: 8123470994 Enrollment ID: I20240117002097 |
| Provider Name | Jeffrey Ray Fulkerson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417457623 PECOS PAC ID: 8820440621 Enrollment ID: I20240117002594 |
| Provider Name | Lee Ann Weiler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922749357 PECOS PAC ID: 9234575101 Enrollment ID: I20240313004200 |
| Provider Name | Erica Satoko Sugiyama-hill |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871056978 PECOS PAC ID: 0547706723 Enrollment ID: I20240724001162 |
| Provider Name | Abby Bailly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417789736 PECOS PAC ID: 6608316963 Enrollment ID: I20240912003876 |
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