Healthcare Provider Details

I. General information

NPI: 1396509550
Provider Name (Legal Business Name): BEYOND THERAPY HEALING & TRAINING CENTER, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 W WAHALLA LN
PHOENIX AZ
85027-4331
US

IV. Provider business mailing address

661 WASHINGTON ST UNIT 364
CANTON MA
02021-0230
US

V. Phone/Fax

Practice location:
  • Phone: 781-739-2018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMANDA BRIGGS
Title or Position: PRESIDENT
Credential: LCSW,LICSW
Phone: 617-650-5412