Healthcare Provider Details

I. General information

NPI: 1619428356
Provider Name (Legal Business Name): SURGE POINTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17505 N 79TH AVE STE 410
GLENDALE AZ
85308-8725
US

IV. Provider business mailing address

17505 N 79TH AVE STE 410
GLENDALE AZ
85308-8725
US

V. Phone/Fax

Practice location:
  • Phone: 623-800-7980
  • Fax: 623-242-1107
Mailing address:
  • Phone: 623-800-7980
  • Fax: 623-242-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: RICHARD I RUFF
Title or Position: OWNER
Credential: LPC
Phone: 623-800-7980