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General NPI Number Information
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NPI Number | 1013616697
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Entity Type | Organization
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Legal Business Name | AZTHERAPYTOK, LLC
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 15331 W. BELL ROAD, SUITE 212-19 BONNIE DENDOOVEN
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City | SURPRISE
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State | AZ
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Zip | 85374-8537
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Country | US
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Telephone | 928-231-2411
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Fax | 928-231-2411
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Provider Business Mailing Address
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Address Line | 15331 W. BELL ROAD, SUITE 212-19 BONNIE DENDOOVEN
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City | SURPRISE
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State | AZ
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Zip | 85374-8537
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Country | US
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Telephone | 928-231-2411
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Fax | 928-231-2411
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Authorized Official
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Title or Position | ORGANIZING DIRECTOR
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Name | BONNIE DEN DOOVEN
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Credential | MC, LPC, CSAT, CMAT
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Telephone | 928-231-2411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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