MEDICARE: PHYLLIS OTU LSAT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LSAT-15163	AZ

General Provider Information

NPI Number	:	1447082359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS OTU LSAT

Provider Business Mailing Address
First Line	:	205 E OSBORN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2327
Country	:	US
Telephone Number	:	833-445-3711
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 E OSBORN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2327
Country	:	US
Telephone Number	:	833-445-3711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	08/19/2024

Similar Medicare Providers

1841337441 — DR. MARC ANTHONY BRODEUR DC
Practice Location Address:

201 E OSBORN RD
PHOENIX, AZ
85012-2327

Practice Phone: 602-532-9544
Practice Fax:

1174660773 — DR. CARMEN NOELLE BRODEUR DC
Practice Location Address:

201 E OSBORN RD
PHOENIX, AZ
85012-2327

Practice Phone: 602-532-9544
Practice Fax:

1700075504 — DR. JUSTIN R. WRIGHT, D.C., P.C.
Practice Location Address:

201 E OSBORN RD
PHOENIX, AZ
85012-2327

Practice Phone: 602-798-6867
Practice Fax:

1518143981 — DR. ALAN RUSS LUNDEEN D.C.
Practice Location Address:

201 E OSBORN RD
PHOENIX, AZ
85012-2327

Practice Phone: 602-503-1424
Practice Fax: 602-532-9516

1326601790 — DR. DORIAN LORRAE RICHARDSON ND
Practice Location Address:

205 E OSBORN RD
PHOENIX, AZ
85012-2327

Practice Phone: 520-505-1944
Practice Fax:

1952002214 — ATR INTEGRATED LLC
Practice Location Address:

205 E OSBORN RD
PHOENIX, AZ
85012-2327

Practice Phone: 833-455-3711
Practice Fax:

Directions to “ PHYLLIS OTU LSAT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.