MEDICARE: CAASI HEALTH SERVICES 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	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1942880893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAASI HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	5060 N 19TH AVE STE 406-5
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-3210
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5060 N 19TH AVE STE 406-5
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-3210
Country	:	US
Telephone Number	:	602-654-1548
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	MR. CHRISTIA REY
Credential	:	JD
Telephone Number	:	910-922-1914

Provider Enumeration Date	:	04/13/2021
Last Update Date	:	04/13/2021

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