Healthcare Provider Details

I. General information

NPI: 1093524324
Provider Name (Legal Business Name): PROSEV VENTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20427 W BRIARWOOD DR
BUCKEYE AZ
85396-1829
US

IV. Provider business mailing address

20427 W BRIARWOOD DR
BUCKEYE AZ
85396-1829
US

V. Phone/Fax

Practice location:
  • Phone: 480-390-4918
  • Fax:
Mailing address:
  • Phone: 480-390-4918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARTIN PROSEV
Title or Position: CEO
Credential:
Phone: 480-390-4918