Healthcare Provider Details

I. General information

NPI: 1083475800
Provider Name (Legal Business Name): ARIZONA INTEGRATED THERAPIES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18940 N PIMA RD STE D165
SCOTTSDALE AZ
85255-5394
US

IV. Provider business mailing address

7106 N VIA NUEVA
SCOTTSDALE AZ
85258-3728
US

V. Phone/Fax

Practice location:
  • Phone: 269-762-1010
  • 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 Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: CORINNE CLANCY GRABER
Title or Position: OWNER
Credential: LPC
Phone: 269-762-1010