Basic Information
| Provider Information | |||||||||
| NPI: | 1902430572 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THERAPEZ | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3118 W MEADOW DR | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850531826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203131859 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3118 W MEADOW DR | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850531826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203131859 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2020 | ||||||||
| LastUpdateDate: | 02/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | PARRA | ||||||||
| AuthorizedOfficialFirstName: | LAUREN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5203131859 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 02/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320600000X | Y | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
No ID Information.