Healthcare Provider Details

I. General information

NPI: 1083114458
Provider Name (Legal Business Name): DANA THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18205 N 51ST AVE STE 131
GLENDALE AZ
85308-1492
US

IV. Provider business mailing address

18205 N 51ST AVE STE 131
GLENDALE AZ
85308-1492
US

V. Phone/Fax

Practice location:
  • Phone: 602-499-5329
  • Fax:
Mailing address:
  • Phone: 602-499-5329
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JAMIE DANA
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 602-499-5329