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General NPI Number Information
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NPI Number | 1710518337
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Entity Type | Organization
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Legal Business Name | STRONG HOUSE OF HEALING
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Dates
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Enumeration Date | 02/01/2020
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Last Update Date | 02/01/2020
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Provider Practice Location Address
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Address Line | 40800 W RIO GRANDE DR
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City | MARICOPA
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State | AZ
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Zip | 85138-1805
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Country | US
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Telephone | 520-213-8336
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Fax |
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Provider Business Mailing Address
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Address Line | 40800 W RIO GRANDE DR
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City | MARICOPA
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State | AZ
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Zip | 85138-1805
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MERCEDES BOOKER
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Credential |
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Telephone | 602-832-9500
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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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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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