=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083094122
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW ADAPTATIONS PSYCHOTHERAPY SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2015
-----------------------------------------------------
Last Update Date | 06/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3303 E BASELINE RD SUITE 114
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85234-2738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-447-7073
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4108 E DOWNING ST
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85205-6253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-447-7073
-----------------------------------------------------
Fax | 480-219-4182
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | LYNN S BRIMHALL
-----------------------------------------------------
Credential | MSW, LCSW
-----------------------------------------------------
Telephone | 602-570-5280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW-15265
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------