=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952509895
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BILTMORE EVALUATION & TREATMENT SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2345 EAST THOMAS RD SUITE 275
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-957-8822
-----------------------------------------------------
Fax | 602-957-0777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2345 EAST THOMAS RD SUITE 275
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-957-8822
-----------------------------------------------------
Fax | 602-957-0777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | DR. JOHN JOSEPH TOMA
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 602-957-8822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 3197
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------