Healthcare Provider Details

I. General information

NPI: 1093382392
Provider Name (Legal Business Name): EMILY SPENCER MT-BC, NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 N 16TH ST STE 201
PHOENIX AZ
85016-7159
US

IV. Provider business mailing address

918 W EL CAMINO DR
PHOENIX AZ
85021-5543
US

V. Phone/Fax

Practice location:
  • Phone: 602-840-6410
  • Fax:
Mailing address:
  • Phone: 602-909-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number16497
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: