Healthcare Provider Details

I. General information

NPI: 1497411185
Provider Name (Legal Business Name): UNIQUELY YOU PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 W PEORIA AVE STE 122
PHOENIX AZ
85029-3951
US

IV. Provider business mailing address

17425 E CALIENTE DR
FOUNTAIN HILLS AZ
85268-2632
US

V. Phone/Fax

Practice location:
  • Phone: 480-375-0478
  • Fax:
Mailing address:
  • Phone: 480-375-0478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: TARA KIENER
Title or Position: CLINICAL DIRECTOR
Credential: LPC, LBA, BCBA
Phone: 480-375-0478