Healthcare Provider Details

I. General information

NPI: 1376888925
Provider Name (Legal Business Name): ELIZABETH ANNE JOHNSON MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANNE FARRELL MT-BC

II. Dates (important events)

Enumeration Date: 12/09/2012
Last Update Date: 12/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 S HIGLEY RD BUILDING 5, SUITE 111
GILBERT AZ
85296-4799
US

IV. Provider business mailing address

7770 E VALLEY VISTA LN
SCOTTSDALE AZ
85250-4730
US

V. Phone/Fax

Practice location:
  • Phone: 480-474-4173
  • Fax: 480-237-9727
Mailing address:
  • Phone: 602-828-7144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number09058
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: