Healthcare Provider Details

I. General information

NPI: 1164155073
Provider Name (Legal Business Name): PHOENIX DREAM CENTER BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 GRAND AVE STE 125
PHOENIX AZ
85017-4504
US

IV. Provider business mailing address

3210 GRAND AVE
PHOENIX AZ
85017-4504
US

V. Phone/Fax

Practice location:
  • Phone: 602-346-8700
  • Fax:
Mailing address:
  • Phone: 602-346-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRIAN D STEELE
Title or Position: CEO
Credential:
Phone: 602-346-8784