Healthcare Provider Details

I. General information

NPI: 1275252801
Provider Name (Legal Business Name): LK INSTITUTE IOP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 N 3RD ST STE 400
PHOENIX AZ
85012-2083
US

IV. Provider business mailing address

4001 N 3RD ST STE 400
PHOENIX AZ
85012-2083
US

V. Phone/Fax

Practice location:
  • Phone: 623-432-8066
  • Fax:
Mailing address:
  • Phone: 623-432-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. AARON KISER
Title or Position: COO
Credential:
Phone: 623-432-8066