Provider Demographics
NPI:1184218034
Name:MODERN RELATIONSHIPS AND MILESTONES, LLC
Entity Type:Organization
Organization Name:MODERN RELATIONSHIPS AND MILESTONES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-206-0232
Mailing Address - Street 1:4725 S CLARK DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7455
Mailing Address - Country:US
Mailing Address - Phone:602-206-0232
Mailing Address - Fax:480-347-2684
Practice Address - Street 1:3200 N DOBSON RD STE C
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-9609
Practice Address - Country:US
Practice Address - Phone:480-424-5470
Practice Address - Fax:480-424-2684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty