Healthcare Provider Details

I. General information

NPI: 1598471971
Provider Name (Legal Business Name): THE COMPLEX TRAUMA RESEARCH AND ADVOCACY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 N CENTRAL AVE # 831
PHOENIX AZ
85004-2185
US

IV. Provider business mailing address

522 N CENTRAL AVE # 831
PHOENIX AZ
85004-2185
US

V. Phone/Fax

Practice location:
  • Phone: 480-810-2910
  • Fax:
Mailing address:
  • Phone: 480-810-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL W SMART
Title or Position: MANAGING DIRECTOR / PRESIDENT
Credential: PH.D.
Phone: 480-810-2910