MEDICARE: 12 STEPS FOR CHRISTIAN LIVING

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	101YP1600X	Pastoral Counselor
5	101YP2500X	Professional Counselor
6	102L00000X	Psychoanalyst
7	106H00000X	Marriage & Family Therapist
8	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1396128229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	12 STEPS FOR CHRISTIAN LIVING

Provider Business Mailing Address
First Line	:	2111 E BASELINE RD STE C8
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1521
Country	:	US
Telephone Number	:	480-831-1212
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 E BASELINE RD STE C8
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1521
Country	:	US
Telephone Number	:	480-831-1212
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT LEIGHTON STADHEIM
Credential	:
Telephone Number	:	480-831-1212

Provider Enumeration Date	:	07/09/2015
Last Update Date	:	07/09/2015

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Directions to “12 STEPS FOR CHRISTIAN LIVING ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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