Healthcare Provider Details

I. General information

NPI: 1811764319
Provider Name (Legal Business Name): ASCEND BEHAVIORAL HEALTH AND EMPOWERMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 N 27TH AVE STE 567
PHOENIX AZ
85017-1763
US

IV. Provider business mailing address

6025 N 27TH AVE STE 567
PHOENIX AZ
85017-1763
US

V. Phone/Fax

Practice location:
  • Phone: 480-630-6691
  • Fax:
Mailing address:
  • Phone: 480-630-6691
  • 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 Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTIN FLORES
Title or Position: OWNER
Credential:
Phone: 602-695-5019