Healthcare Provider Details

I. General information

NPI: 1528954104
Provider Name (Legal Business Name): CILICIA'S INTERNATIONAL HOLDING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST # 6253
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

4539 N 22ND ST # 6253
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 480-328-4410
  • Fax:
Mailing address:
  • Phone: 480-328-4410
  • 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

VIII. Authorized Official

Name: MS. CILICIA T GOODEN
Title or Position: PROVIDER
Credential: LCSW
Phone: 480-328-4410