Healthcare Provider Details

I. General information

NPI: 1306772934
Provider Name (Legal Business Name): TAGBE-TOE DANIEL GOE RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 N 75TH AVE APT 1083
GLENDALE AZ
85303-2518
US

IV. Provider business mailing address

7111 N 75TH AVE APT 1083
GLENDALE AZ
85303-2518
US

V. Phone/Fax

Practice location:
  • Phone: 602-907-7855
  • Fax:
Mailing address:
  • Phone: 602-907-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: