Healthcare Provider Details

I. General information

NPI: 1124779962
Provider Name (Legal Business Name): GOLD METTLE RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 03/09/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12211 W BELL RD STE 106
SURPRISE AZ
85378-9655
US

IV. Provider business mailing address

12211 W BELL RD STE 106
SURPRISE AZ
85378-9655
US

V. Phone/Fax

Practice location:
  • Phone: 480-808-5150
  • Fax: 602-975-3460
Mailing address:
  • Phone: 480-808-5150
  • Fax: 602-975-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GOLDMAN
Title or Position: OWNER
Credential:
Phone: 480-335-2859