Healthcare Provider Details

I. General information

NPI: 1518205467
Provider Name (Legal Business Name): MIND-FULL MUSIC THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 E BEATRYCE ST
TEMPE AZ
85281-1001
US

IV. Provider business mailing address

PO BOX 67777
PHOENIX AZ
85082-7777
US

V. Phone/Fax

Practice location:
  • Phone: 480-363-9524
  • Fax:
Mailing address:
  • Phone: 480-363-9524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH R. KRET
Title or Position: EXECUTIVE DIRECTOR
Credential: MM, MT-BC, NMT
Phone: 480-363-9524