MEDICARE: CHAPTER 1, STARTING OVER 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1396619144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAPTER 1, STARTING OVER LLC

Provider Business Mailing Address
First Line	:	5923 S 12TH LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-0023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4225 W GLENDALE AVE STE E104
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-8153
Country	:	US
Telephone Number	:	336-459-5623
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	KELLY ROGERS
Credential	:
Telephone Number	:	336-459-5623

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	02/03/2026

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Directions to “CHAPTER 1, STARTING OVER LLC ” Practice Location

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