MEDICARE: TEMPE TRAILS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1386403053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEMPE TRAILS LLC

Provider Business Mailing Address
First Line	:	2210 S MILL AVE STE 7C
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-2153
Country	:	US
Telephone Number	:	480-400-9615
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 S MILL AVE STE 7C
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-2153
Country	:	US
Telephone Number	:	480-400-9615
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR, FOUNDER
Name	:	BRENTON WEJROWSKI
Credential	:	MC, LPC
Telephone Number	:	480-400-9615

Provider Enumeration Date	:	03/15/2024
Last Update Date	:	04/07/2026

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Directions to “TEMPE TRAILS LLC ” Practice Location

Language	Start Address	Practice Location

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