Healthcare Provider Details

I. General information

NPI: 1851869127
Provider Name (Legal Business Name): JMS SERENITY FIRST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N LA CANADA DR STE 30C
GREEN VALLEY AZ
85614-3139
US

IV. Provider business mailing address

136 W VUELTA FRISO
SAHUARITA AZ
85629-8672
US

V. Phone/Fax

Practice location:
  • Phone: 520-398-7272
  • Fax: 520-771-8291
Mailing address:
  • Phone: 520-398-7272
  • Fax: 520-771-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOAN M SILVER
Title or Position: AGENT
Credential: LMFT
Phone: 520-398-7272