Healthcare Provider Details

I. General information

NPI: 1942880893
Provider Name (Legal Business Name): CAASI HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 N 19TH AVE STE 406-5
PHOENIX AZ
85015-3210
US

IV. Provider business mailing address

5060 N 19TH AVE STE 406-5
PHOENIX AZ
85015-3210
US

V. Phone/Fax

Practice location:
  • Phone: 602-654-1548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTIA REY
Title or Position: CHIEF OPERATIONS OFFICER
Credential: JD
Phone: 910-922-1914