=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386049104
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UPWARD SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2014
-----------------------------------------------------
Last Update Date | 04/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11024 NORTH 28TH DRIVE - SUITE #200 LAKE BILTMORE CORPORATE CENTER
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-332-6115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3039 WEST PEORIA AVE. SUITE # C-102-164
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-332-6115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/COUNSELOR - THERAPIST
-----------------------------------------------------
Name | DR. MAURIE S. COMENZO
-----------------------------------------------------
Credential | PHD, LPC, ABCAC
-----------------------------------------------------
Telephone | 602-332-6115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | ABCAC#1908
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LPC#11904
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC#11904
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | LPC#11904
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------