Healthcare Provider Details

I. General information

NPI: 1598135352
Provider Name (Legal Business Name): GREENSPRING MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 W GREENWAY RD APT 241
GLENDALE AZ
85306-5224
US

IV. Provider business mailing address

5959 W GREENWAY RD APT 241
GLENDALE AZ
85306-5224
US

V. Phone/Fax

Practice location:
  • Phone: 602-395-0718
  • Fax:
Mailing address:
  • Phone: 602-395-0718
  • Fax: 602-277-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14167
License Number StateAZ

VIII. Authorized Official

Name: JACK RODDY
Title or Position: SOLE MBR
Credential:
Phone: 602-395-0718