Growing Edges Llc | |
18205 N 51st Ave Bldg 2 Suite 115 Glendale AZ 85308-1490 | |
(602) 548-1444 | |
(602) 548-1446 |
Full Name | Growing Edges Llc |
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Speciality | Psychologist |
Location | 18205 N 51st Ave Bldg 2, Glendale, Arizona |
Authorized Official Name and Position | Ilyssa Swartout (PRESIDENT) |
Authorized Official Contact | 6025481444 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Growing Edges Llc 19580 W Indian School Rd Ste 105-134 Buckeye AZ 85396-2081 Ph: (602) 548-1444 | Growing Edges Llc 18205 N 51st Ave Bldg 2 Suite 115 Glendale AZ 85308-1490 Ph: (602) 548-1444 |
NPI Number | 1073739660 |
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Provider Enumeration Date | 04/18/2007 |
Last Update Date | 09/21/2022 |
Certification Date | 09/21/2022 |
Medicare PECOS PAC ID | 6103818208 |
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Medicare Enrollment ID | O20040331000033 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073739660 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
Provider Name | Ilyssa P Swartout |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1881630325 PECOS PAC ID: 5991797094 Enrollment ID: I20040414001195 |
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