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General NPI Number Information
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NPI Number | 1144786245
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Entity Type | Organization
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Legal Business Name | CENTER FOR PROGRESSIVE THERAPIES LLC
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 11011 S 48TH ST STE 101
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City | PHOENIX
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State | AZ
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Zip | 85044-1787
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Country | US
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Telephone | 480-223-8263
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Fax | 480-247-5705
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Provider Business Mailing Address
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Address Line | 11011 S 48TH ST STE 101
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City | PHOENIX
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State | AZ
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Zip | 85044-1787
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Country | US
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Telephone | 480-223-8263
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MYSTI RACHELLE RAINWATER
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Credential | MA, LPC
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Telephone | 480-223-8263
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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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