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General NPI Number Information
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NPI Number | 1093167108
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Entity Type | Organization
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Legal Business Name | TBM MENTAL HEALTH LLC
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 17431 N 71ST DR SUITE 104
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City | GLENDALE
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State | AZ
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Zip | 85308-8598
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Country | US
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Telephone | 480-521-6586
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Fax |
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Provider Business Mailing Address
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Address Line | 17431 N 71ST DR SUITE 104
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City | GLENDALE
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State | AZ
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Zip | 85308-8598
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Country | US
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Telephone | 480-521-6586
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Fax |
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Authorized Official
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Title or Position | MBR
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Name | TIMOTHY MILLER
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Credential |
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Telephone | 480-521-6586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | RN1348
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License Number State | AZ
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