Healthcare Provider Details

I. General information

NPI: 1174313159
Provider Name (Legal Business Name): SUNAURA THERAPY COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST STE R
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

4539 N 22ND ST STE R
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 888-454-1606
  • Fax: 888-612-0942
Mailing address:
  • Phone: 888-454-1606
  • Fax: 888-612-0942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA MURPHY
Title or Position: OWNER
Credential:
Phone: 888-454-1606