Healthcare Provider Details

I. General information

NPI: 1295479244
Provider Name (Legal Business Name): THE NEWSTART INTEGRATED HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 09/18/2022
Certification Date: 09/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 N 24TH AVE STE 120&130
PHOENIX AZ
85015-5947
US

IV. Provider business mailing address

15213 N 143RD AVE
SURPRISE AZ
85379-8542
US

V. Phone/Fax

Practice location:
  • Phone: 602-358-9175
  • Fax:
Mailing address:
  • Phone: 602-358-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANALIZA DE PEDRO
Title or Position: MEMBER
Credential:
Phone: 602-358-9175