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General NPI Number Information
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NPI Number | 1972979862
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Entity Type | Organization
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Legal Business Name | LIFE TRANSFORMATION RECOVERY
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Dates
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Enumeration Date | 08/14/2015
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 8521 E FLORENTINE RD STE B
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-8954
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Country | US
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Telephone | 928-515-0044
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Fax | 928-433-4977
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Provider Business Mailing Address
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Address Line | 8521 E FLORENTINE RD STE B
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-8954
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Country | US
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Telephone | 928-515-0044
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Fax | 928-433-4977
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DAVID SANCHEZ
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Credential |
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Telephone | 928-515-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | OTC7200
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License Number State | AZ
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