Healthcare Provider Details

I. General information

NPI: 1215528377
Provider Name (Legal Business Name): STEP BY STEP MENTORING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 N 78TH AVE
PHOENIX AZ
85035-5144
US

IV. Provider business mailing address

2210 N 78TH AVE
PHOENIX AZ
85035-5144
US

V. Phone/Fax

Practice location:
  • Phone: 480-547-7356
  • Fax:
Mailing address:
  • Phone: 480-547-7356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JONIA M COLEMAN
Title or Position: OWNER
Credential:
Phone: 480-547-7356