| Teen Out Reach Services | |
|
544 S 96th Pl Mesa AZ 85208-2512 | |
| (480) 696-0338 | |
| Not Available |
| Full Name | Teen Out Reach Services |
|---|---|
| Speciality | Psychologist |
| Location | 544 S 96th Pl, Mesa, Arizona |
| Authorized Official Name and Position | Amanda Reane Johnson (DIRECTOR) |
| Authorized Official Contact | 4806960338 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Teen Out Reach Services 544 S 96th Pl Apt 2080 Mesa AZ 85208-2512 Ph: (480) 696-0338 | Teen Out Reach Services 544 S 96th Pl Mesa AZ 85208-2512 Ph: (480) 696-0338 |
| NPI Number | 1982289062 |
|---|---|
| Provider Enumeration Date | 03/10/2021 |
| Last Update Date | 06/03/2021 |
| Certification Date | 06/03/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982289062 | NPI | - | NPPES |
| 282NC0060X | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| 282NC0060X | General Acute Care Hospital - Critical Access | (* (Not Available)) | Secondary |
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