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General NPI Number Information
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NPI Number | 1255818100
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Entity Type | Organization
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Legal Business Name | US VETS-ARIZONA
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Dates
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Enumeration Date | 07/24/2018
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Last Update Date | 07/24/2018
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Provider Practice Location Address
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Address Line | 3400 GRAND AVE
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City | PHOENIX
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State | AZ
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Zip | 85017-4507
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Country | US
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Telephone | 602-739-2552
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Fax |
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Provider Business Mailing Address
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Address Line | 3507 N CENTRAL AVE
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City | PHOENIX
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State | AZ
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Zip | 85012-2118
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Country | US
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Telephone | 602-501-5548
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Fax | 602-441-0613
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MICHELLE JAMESON
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Credential |
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Telephone | 602-501-5548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC-11703
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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