Provider Demographics
NPI:1013374123
Name:SOCIAL ANXIETY INSTITUTE, INC.
Entity Type:Organization
Organization Name:SOCIAL ANXIETY INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO, PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-230-7316
Mailing Address - Street 1:2058 E TOPEKA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-2404
Mailing Address - Country:US
Mailing Address - Phone:602-230-7316
Mailing Address - Fax:
Practice Address - Street 1:2058 E TOPEKA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-2404
Practice Address - Country:US
Practice Address - Phone:602-230-7316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty