Healthcare Provider Details

I. General information

NPI: 1689376436
Provider Name (Legal Business Name): ITS BIGGER THAN ME IBTM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3519 E SHEA BLVD STE 119A
PHOENIX AZ
85028-3341
US

IV. Provider business mailing address

IT'S BIGGER THAN ME , ATTN: ERICA HOLMES 4949 E. VANBUREN ST. #61024
PHOENIX AZ
85026
US

V. Phone/Fax

Practice location:
  • Phone: 602-448-8007
  • 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
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ERICA HOLMES
Title or Position: OWNER
Credential:
Phone: 612-483-5527