Healthcare Provider Details

I. General information

NPI: 1700467149
Provider Name (Legal Business Name): ASBURRY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 05/30/2021
Certification Date: 05/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34406 N 27TH DR STE 140
PHOENIX AZ
85085-6079
US

IV. Provider business mailing address

34406 N 27TH DR STE 140
PHOENIX AZ
85085-6079
US

V. Phone/Fax

Practice location:
  • Phone: 602-402-1711
  • Fax:
Mailing address:
  • Phone: 602-402-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KELLEY ASBURRY
Title or Position: THERAPIST
Credential: LCSW
Phone: 602-402-1711