Healthcare Provider Details

I. General information

NPI: 1265940092
Provider Name (Legal Business Name): CFG, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 01/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10446 N 74TH ST STE 140
SCOTTSDALE AZ
85258-1045
US

IV. Provider business mailing address

4616 N 33RD PL
PHOENIX AZ
85018-3958
US

V. Phone/Fax

Practice location:
  • Phone: 480-699-9044
  • Fax:
Mailing address:
  • Phone: 480-699-9044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. RUSSELL FERRARA
Title or Position: CEO
Credential:
Phone: 561-926-4223