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General NPI Number Information
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NPI Number | 1679088363
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Entity Type | Organization
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Legal Business Name | CENTER FOR THERAPY AND MINDFULNESS
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 2807 N 51ST ST
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City | PHOENIX
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State | AZ
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Zip | 85008-1613
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Country | US
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Telephone | 646-256-0429
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Fax |
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Provider Business Mailing Address
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Address Line | 2807 N 51ST ST
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City | PHOENIX
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State | AZ
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Zip | 85008-1613
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Country | US
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Telephone | 646-256-0429
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. STACI DAVIS
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Credential | PSY.D
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Telephone | 480-410-2238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 4519
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License Number State | AZ
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