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General NPI Number Information
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NPI Number | 1477916203
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Entity Type | Organization
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Legal Business Name | STEP UP ARIZONA
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 12725 W INDIAN SCHOOL RD # E109
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City | AVONDALE
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State | AZ
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Zip | 85392-9520
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Country | US
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Telephone | 602-361-9724
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Fax |
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Provider Business Mailing Address
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Address Line | 12725 W INDIAN SCHOOL RD # E109
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City | AVONDALE
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State | AZ
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Zip | 85392-9520
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Country | US
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Telephone | 602-361-9724
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | KIM MOLINA
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Credential | MA
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Telephone | 623-466-7233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CSLG7614
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License Number State | AZ
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