Healthcare Provider Details

I. General information

NPI: 1457051948
Provider Name (Legal Business Name): STEPSUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3458 E SOUTHERN AVE STE 103
MESA AZ
85204-5681
US

IV. Provider business mailing address

3458 E SOUTHERN AVE STE 103
MESA AZ
85204-5681
US

V. Phone/Fax

Practice location:
  • Phone: 480-569-3377
  • Fax:
Mailing address:
  • Phone: 480-569-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. OLUKEMI AKINBUSUYI
Title or Position: ADMINISTRATOR
Credential: MA
Phone: 480-569-3377