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General NPI Number Information
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NPI Number | 1316712441
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Entity Type | Organization
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Legal Business Name | PARK PLACE RECOVERY AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 13916 N 135TH DR
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City | SURPRISE
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State | AZ
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Zip | 85379-8428
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Country | US
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Telephone | 623-462-8187
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Fax |
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Provider Business Mailing Address
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Address Line | 13916 N 135TH DR
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City | SURPRISE
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State | AZ
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Zip | 85379-8428
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TARA L CHASE
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Credential | LAC, MS
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Telephone | 623-462-8187
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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 |
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License Number State |
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