| Track House Life, Llc | |
|
4205 N 7th Ave Ste 307 Phoenix AZ 85013 | |
| (602) 522-2595 | |
| (602) 258-4996 |
| Full Name | Track House Life, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4205 N 7th Ave Ste 307, Phoenix, Arizona |
| Authorized Official Name and Position | Angela Roberson (PRESIDENT) |
| Authorized Official Contact | 6025222595 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Track House Life, Llc 4205 N 7th Ave Ste 307 Phoenix AZ 85013-3080 Ph: (602) 522-2595 | Track House Life, Llc 4205 N 7th Ave Ste 307 Phoenix AZ 85013 Ph: (602) 522-2595 |
| NPI Number | 1447302914 |
|---|---|
| Provider Enumeration Date | 01/17/2007 |
| Last Update Date | 06/19/2018 |
| Medicare PECOS PAC ID | 1557303120 |
|---|---|
| Medicare Enrollment ID | O20050524000677 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447302914 | NPI | - | NPPES |
| Provider Name | Buffy T Wooten |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295727964 PECOS PAC ID: 9133285414 Enrollment ID: I20120404000701 |
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