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General NPI Number Information
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NPI Number | 1497233126
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Entity Type | Organization
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Legal Business Name | RAPPORT1ST LLC
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Dates
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Enumeration Date | 08/03/2018
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Last Update Date | 08/03/2018
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Provider Practice Location Address
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Address Line | 2601 N 3RD ST STE 303
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City | PHOENIX
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State | AZ
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Zip | 85004-1101
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Country | US
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Telephone | 602-486-6581
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Fax | 602-368-5999
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Provider Business Mailing Address
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Address Line | 2601 N 3RD ST STE 303
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City | PHOENIX
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State | AZ
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Zip | 85004-1101
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Country | US
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Telephone | 602-486-6581
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Fax | 602-368-5999
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Authorized Official
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Title or Position | CEO
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Name | MR. ADDAM L GROSS
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Credential | PSYD
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Telephone | 602-486-6581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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