Healthcare Provider Details

I. General information

NPI: 1710347042
Provider Name (Legal Business Name): ARIZONA FAMILY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3048 E BASELINE RD SUITE 107
MESA AZ
85204-7286
US

IV. Provider business mailing address

1425 S LINDSAY RD UNIT 36
MESA AZ
85204-6230
US

V. Phone/Fax

Practice location:
  • Phone: 317-258-0338
  • Fax:
Mailing address:
  • Phone: 317-258-0338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13703
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ALLISON SPENCER
Title or Position: CLINICIAN
Credential: LCSW
Phone: 317-258-0338