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General NPI Number Information
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NPI Number | 1871065615
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Entity Type | Organization
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Legal Business Name | VALLEY ADDICTION & MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 12/18/2018
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 16845 N. 29TH AVE STE 1-211
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City | PHOENIX
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State | AZ
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Zip | 85053
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Country | US
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Telephone | 602-456-1008
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Fax | 602-993-2323
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Provider Business Mailing Address
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Address Line | 16845 N. 29TH AVE STE 1-211
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City | PHOENIX
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State | AZ
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Zip | 85053
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Country | US
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Telephone | 602-456-1008
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Fax | 602-993-2323
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Authorized Official
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Title or Position | OWNER/CEO
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Name | GLENN P. TOWNSEND
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Credential | NP
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Telephone | 602-456-1008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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