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General NPI Number Information
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NPI Number | 1396594909
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Entity Type | Organization
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Legal Business Name | SERA TREATMENT CORPORATION
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Dates
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Enumeration Date | 05/15/2024
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 9005 N 29TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85051-3465
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Country | US
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Telephone | 602-708-2897
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Fax |
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Provider Business Mailing Address
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Address Line | 3135 W HAYWARD AVE
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City | PHOENIX
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State | AZ
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Zip | 85051-6544
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Country | US
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Telephone | 602-708-2897
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ALICIA DADEAH
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Credential | MPH
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Telephone | 602-708-2897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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