MEDICARE: INTO PLACE THERAPY, 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1790669935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTO PLACE THERAPY, LLC

Provider Business Mailing Address
First Line	:	101 N 1ST AVE STE 2325
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85003-1933
Country	:	US
Telephone Number	:	602-341-3062
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 N 1ST AVE STE 2325
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85003-1933
Country	:	US
Telephone Number	:	602-341-3062
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND PSYCHOTHERAPIST
Name	:	ISABEL BALL
Credential	:	LCSW
Telephone Number	:	520-668-8517

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	08/01/2025

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