Healthcare Provider Details

I. General information

NPI: 1437300506
Provider Name (Legal Business Name): ABC THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 HIGHWAY 95 SUITE N-104
BULLHEAD CITY AZ
86442-7860
US

IV. Provider business mailing address

3003 HIGHWAY 95 SUITE N-104
BULLHEAD CITY AZ
86442-7860
US

V. Phone/Fax

Practice location:
  • Phone: 928-763-0250
  • Fax: 928-763-0271
Mailing address:
  • Phone: 928-763-0250
  • Fax: 928-763-0271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberBH-3065
License Number StateAZ

VIII. Authorized Official

Name: MS. PATRICIA A. ARCHER
Title or Position: COUNSELOR
Credential: THERAPIST
Phone: 928-763-0250