| Gotham Ranch, Llc | |
|
4342 E Edgewood Ave Mesa AZ 85206-2646 | |
| (480) 577-5327 | |
| Not Available |
| Full Name | Gotham Ranch, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 4342 E Edgewood Ave, Mesa, Arizona |
| Authorized Official Name and Position | Jessica Lynn Breznak-higgins (OWNER/COUNSELOR) |
| Authorized Official Contact | 4805775327 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gotham Ranch, Llc 4342 E Edgewood Ave Mesa AZ 85206-2646 Ph: (480) 577-5327 | Gotham Ranch, Llc 4342 E Edgewood Ave Mesa AZ 85206-2646 Ph: (480) 577-5327 |
| NPI Number | 1609353077 |
|---|---|
| Provider Enumeration Date | 07/27/2018 |
| Last Update Date | 12/02/2023 |
| Certification Date | 12/02/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609353077 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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