Healthcare Provider Details

I. General information

NPI: 1306614714
Provider Name (Legal Business Name): THERESA SEWARD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 W BELL RD STE A102
SURPRISE AZ
85378-9707
US

IV. Provider business mailing address

PO BOX 2078
SUN CITY AZ
85372-2078
US

V. Phone/Fax

Practice location:
  • Phone: 623-330-1099
  • Fax: 623-583-3888
Mailing address:
  • Phone: 623-330-1099
  • Fax: 623-583-3888

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 State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THERESA SEWARD
Title or Position: OWNER
Credential: LPC
Phone: 623-330-1099