MEDICARE: ARIZONA OCD AND ANXIETY CENTER, 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	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPC-19481	OTHER	AZ	ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS

General Provider Information

NPI Number	:	1528731767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA OCD AND ANXIETY CENTER, LLC

Provider Business Mailing Address
First Line	:	29038 N CARNELIAN DR
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-6269
Country	:	US
Telephone Number	:	602-755-2384
Fax Number	:

Provider Business Practice Location Address
First Line	:	29038 N CARNELIAN DR
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-6269
Country	:	US
Telephone Number	:	602-755-2384
Fax Number	:

Authorized Official
Title or Position	:	OWNER / PROFESSIONAL COUNSELOR(LPC)
Name	:	ANDREW MCBRIDE
Credential	:	LPC
Telephone Number	:	602-755-2384

Provider Enumeration Date	:	07/25/2021
Last Update Date	:	08/03/2021

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