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General NPI Number Information
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NPI Number | 1922260082
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Entity Type | Organization
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Legal Business Name | MY THERAPIST INC
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 2435 E SOUTHERN AVE STE 2
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City | TEMPE
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State | AZ
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Zip | 85282
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Country | US
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Telephone | 480-205-0062
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Fax | 480-775-2789
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Provider Business Mailing Address
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Address Line | 2435 E SOUTHERN AVE STE 2
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City | TEMPE
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State | AZ
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Zip | 85282
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Country | US
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Telephone | 480-205-0062
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Fax | 480-775-2789
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Authorized Official
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Title or Position | PRESIDENT OF MY THERAPIST INC
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Name | PATRICIA L BRADLEY BATES
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Credential | MED LPC LISAC
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Telephone | 480-205-0062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC0052
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License Number State | AZ
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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 | LPC0757
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License Number State | AZ
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