MEDICARE: HOPSCOTCH CLINICAL SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1912463217	OTHER		MENTAL HEALTH COUNSELING

General Provider Information

NPI Number	:	1205577426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPSCOTCH CLINICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	8400 S KYRENE RD STE 225
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-2177
Country	:	US
Telephone Number	:	623-335-2007
Fax Number	:	833-704-1908

Provider Business Practice Location Address
First Line	:	51 W ELLIOT RD STE 110
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-1311
Country	:	US
Telephone Number	:	623-335-2007
Fax Number	:	833-704-1908

Authorized Official
Title or Position	:	OWNER/COUNSELOR
Name	:	ELIZABETH HIGHTOWER
Credential	:	LPC
Telephone Number	:	602-818-5445

Provider Enumeration Date	:	04/03/2022
Last Update Date	:	02/05/2024

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