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General NPI Number Information
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NPI Number | 1790393197
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Entity Type | Organization
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Legal Business Name | JOVEN HEALTH, LLC
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 3635 E LARSON LN
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City | GILBERT
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State | AZ
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Zip | 85295-7229
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Country | US
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Telephone | 734-486-5579
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Fax |
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Provider Business Mailing Address
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Address Line | 3854 S HALIFAX ST
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City | AURORA
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State | CO
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Zip | 80013-3973
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Country | US
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Telephone | 734-486-5579
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF BUSINESS DEVELOPMENT
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Name | TYLER LEE MCCORD
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Credential | LMSW
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Telephone | 734-486-5579
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 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 #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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