Healthcare Provider Details

I. General information

NPI: 1831955764
Provider Name (Legal Business Name): ALL OF LIFE BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 E SECRETARIAT DR
TEMPE AZ
85284-1612
US

IV. Provider business mailing address

1204 E SECRETARIAT DR
TEMPE AZ
85284-1612
US

V. Phone/Fax

Practice location:
  • Phone: 480-235-1680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANTHONY THORNTON
Title or Position: MEMBER-MANAGER
Credential:
Phone: 480-235-1680