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4820 S. Mill Ave. Suite 101 Tempe AZ 85282 | |
| (480) 921-4080 | |
| (480) 921-2673 |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 4820 S. Mill Ave., Tempe, Arizona |
| Authorized Official Name and Position | Joshua Azevedo (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4809214050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4820 S. Mill Ave Suite 101 Tempe AZ 85282 Ph: (480) 921-4050 | 4820 S. Mill Ave. Suite 101 Tempe AZ 85282 Ph: (480) 921-4080 |
| NPI Number | 1225209380 |
|---|---|
| Provider Enumeration Date | 03/17/2008 |
| Last Update Date | 05/06/2021 |
| Certification Date | 05/06/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225209380 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | BH-2944 (Arizona) | Primary |
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