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General NPI Number Information
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NPI Number | 1932784709
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Entity Type | Organization
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Legal Business Name | TACKLE HEALTH LLC
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Dates
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Enumeration Date | 03/13/2021
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 2737 W BASELINE RD STE 19
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City | TEMPE
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State | AZ
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Zip | 85283-1051
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Country | US
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Telephone | 480-219-9735
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Fax |
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Provider Business Mailing Address
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Address Line | 2737 W BASELINE RD STE 19
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City | TEMPE
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State | AZ
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Zip | 85283-1051
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Country | US
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Telephone | 480-219-9735
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Fax | 480-219-9558
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Authorized Official
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Title or Position | PRESIDENT
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Name | LACEY LEONARD
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Credential |
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Telephone | 559-403-6365
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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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