Healthcare Provider Details

I. General information

NPI: 1710693643
Provider Name (Legal Business Name): UNIQUE LIFE SKILLS AZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10210 N 92ND ST STE 103
SCOTTSDALE AZ
85258-4523
US

IV. Provider business mailing address

13210 N 72ND PL
SCOTTSDALE AZ
85260-3900
US

V. Phone/Fax

Practice location:
  • Phone: 480-803-6472
  • Fax:
Mailing address:
  • Phone: 480-390-9937
  • 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 Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MITCHELL STEIMAN
Title or Position: CEO
Credential:
Phone: 480-390-9937