Healthcare Provider Details

I. General information

NPI: 1609475144
Provider Name (Legal Business Name): BEST SELF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2020
Last Update Date: 10/24/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 N 31ST AVE STE C100-128
PHOENIX AZ
85051-1356
US

IV. Provider business mailing address

7609 W ROVEY AVE
GLENDALE AZ
85303-4250
US

V. Phone/Fax

Practice location:
  • Phone: 480-295-6181
  • Fax:
Mailing address:
  • Phone: 480-295-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE GORDON
Title or Position: OWNER
Credential: LCSW
Phone: 480-295-6181