MEDICARE: STEPPING STONE TREATMENT 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	103TA0400X	Addiction (Substance Use Disorder) Psychologist

General Provider Information

NPI Number	:	1588338685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPPING STONE TREATMENT CENTER, LLC

Provider Business Mailing Address
First Line	:	3035 E SOUTHERN AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-3714
Country	:	US
Telephone Number	:	630-408-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	3035 E SOUTHERN AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-3714
Country	:	US
Telephone Number	:	630-408-1611
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. ALEXANDER T STONE
Credential	:	MS
Telephone Number	:	630-408-1611

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

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