MEDICARE: THERAPY 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

General Provider Information

NPI Number	:	1376165266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY LLC

Provider Business Mailing Address
First Line	:	1818 E SOUTHERN AVE STE 3A
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5247
Country	:	US
Telephone Number	:	702-906-8889
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 E SOUTHERN AVE STE 3A
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5247
Country	:	US
Telephone Number	:	702-906-8889
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	COURTNEY HAYWOOD
Credential	:
Telephone Number	:	702-906-8889

Provider Enumeration Date	:	05/13/2020
Last Update Date	:	05/13/2020

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Directions to “THERAPY LLC ” Practice Location

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