Healthcare Provider Details

I. General information

NPI: 1134031032
Provider Name (Legal Business Name): MS. MARA LYNNE GROTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 E GREENWAY PKWY # 103-236
SCOTTSDALE AZ
85254-2025
US

IV. Provider business mailing address

6501 E. GREENWAY PKWY. #103-236
SCOTTSDALE AZ
85254
US

V. Phone/Fax

Practice location:
  • Phone: 480-848-2588
  • Fax:
Mailing address:
  • Phone: 480-848-2588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number155433
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: