Healthcare Provider Details

I. General information

NPI: 1285545475
Provider Name (Legal Business Name): AXIS FOR AUTISM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E PLAZA CIR DR STE 505C
LITCHFIELD PARK AZ
85340-4919
US

IV. Provider business mailing address

7720 N 16TH ST STE 325
PHOENIX AZ
85020-7421
US

V. Phone/Fax

Practice location:
  • Phone: 602-888-8882
  • Fax: 602-883-7254
Mailing address:
  • Phone: 602-888-8882
  • Fax: 602-883-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: ANDREA STEVENS
Title or Position: CHIEF STRATEGY OFFICER
Credential:
Phone: 602-888-8882