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4669 N Commerce Dr Ste 4a Sierra Vista AZ 85635 | |
| (520) 255-1421 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 4669 N Commerce Dr Ste 4a, Sierra Vista, Arizona |
| Authorized Official Name and Position | Brooke Reynolds (OWNER/DIRECTOR/PROVIDER) |
| Authorized Official Contact | 5202551421 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
P.o. Box 1716 Sierra Vista AZ 85636-1716 Ph: (520) 255-1421 | 4669 N Commerce Dr Ste 4a Sierra Vista AZ 85635 Ph: (520) 255-1421 |
| NPI Number | 1477281681 |
|---|---|
| Provider Enumeration Date | 08/15/2022 |
| Last Update Date | 07/12/2024 |
| Certification Date | 09/09/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477281681 | NPI | - | NPPES |
| 228604 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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