=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518190255
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPRIOLE THERAPEUTIC SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2009
-----------------------------------------------------
Last Update Date | 08/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14510 W SHUMWAY DR SUITE #202
-----------------------------------------------------
City | SUN CITY WEST
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85375-5814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-293-2282
-----------------------------------------------------
Fax | 866-920-8488
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14510 W SHUMWAY DRIVE SUITE #202
-----------------------------------------------------
City | SUN CITY WEST
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-293-2282
-----------------------------------------------------
Fax | 866-920-8488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. BETH M STODDARD
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 623-293-2282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | LISAC-10994
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC-13208
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------