MEDICARE: RHONDA KIPHUTH LAC

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	320800000X	Mental Illness Community Based Residential Treatment Facility	15424	AZ

General Provider Information

NPI Number	:	1881327179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA KIPHUTH LAC

Provider Business Mailing Address
First Line	:	3338 W KINGS AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2940
Country	:	US
Telephone Number	:	480-660-5775
Fax Number	:	602-926-0590

Provider Business Practice Location Address
First Line	:	3338 W KINGS AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2940
Country	:	US
Telephone Number	:	480-660-5775
Fax Number	:	602-926-0590

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

Provider Enumeration Date	:	07/05/2022
Last Update Date	:	07/05/2022

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Directions to “ RHONDA KIPHUTH LAC” Practice Location

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