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General NPI Number Information
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NPI Number | 1679197024
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Entity Type | Organization
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Legal Business Name | VIRTUAL EDGE THERAPIES
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Dates
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Enumeration Date | 06/02/2020
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 4329 S RIVER VALLEY CT STE A
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-5340
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Country | US
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Telephone | 619-818-7841
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10153
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City | FORT MOHAVE
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State | AZ
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Zip | 86427-0153
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Country | US
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Telephone | 619-818-7841
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Fax |
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Authorized Official
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Title or Position | OWNER/EMPLOYER
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Name | BEVERLY SAILORS
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Credential | MSW LCSW
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Telephone | 619-818-7841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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