MEDICARE: RAISING RESILIENCY, 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	LPC#13546	AZ

General Provider Information

NPI Number	:	1821430471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAISING RESILIENCY, LLC

Provider Business Mailing Address
First Line	:	8715 W. UNION HILLS DR.
Second Line	:	#111
City	:	PEORIA
State	:	AZ
Zip	:	85382-3031
Country	:	US
Telephone Number	:
Fax Number	:	623-328-9539

Provider Business Practice Location Address
First Line	:	8715 W. UNION HILLS DR.
Second Line	:	#111
City	:	PEORIA
State	:	AZ
Zip	:	85382-3031
Country	:	US
Telephone Number	:	602-510-0815
Fax Number	:	623-328-9539

Authorized Official
Title or Position	:	OWNER
Name	:	LAURA L. SMITH
Credential	:
Telephone Number	:	602-510-0815

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	07/24/2013

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