Healthcare Provider Details

I. General information

NPI: 1588716682
Provider Name (Legal Business Name): ANGELA BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N CENTRAL AVE STE 108C
PHOENIX AZ
85020-2869
US

IV. Provider business mailing address

8900 N CENTRAL AVE STE 108C
PHOENIX AZ
85020-2869
US

V. Phone/Fax

Practice location:
  • Phone: 602-748-5200
  • Fax:
Mailing address:
  • Phone: 602-748-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3320482
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC-18459
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLASAC-13294
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number3320482
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: