Healthcare Provider Details

I. General information

NPI: 1114856077
Provider Name (Legal Business Name): AZ NEUROHOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E ROSE GARDEN LN UNIT 71363
PHOENIX AZ
85050-7715
US

IV. Provider business mailing address

2550 E ROSE GARDEN LN UNIT 71363
PHOENIX AZ
85050-7715
US

V. Phone/Fax

Practice location:
  • Phone: 602-510-0413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JANEL RANDLE
Title or Position: CLINICAL DIRECTOR
Credential: MC, LPC
Phone: 480-250-4245