Provider Demographics
NPI:1225135502
Name:PORTABLE PRACTICAL EDUCATION PREPARATION, INC
Entity Type:Organization
Organization Name:PORTABLE PRACTICAL EDUCATION PREPARATION, INC
Other - Org Name:PPEP INTEGRATED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-622-3553
Mailing Address - Street 1:802 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-5006
Mailing Address - Country:US
Mailing Address - Phone:520-622-3553
Mailing Address - Fax:
Practice Address - Street 1:901 E 46TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-5008
Practice Address - Country:US
Practice Address - Phone:520-792-5704
Practice Address - Fax:520-792-5724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSLG7856101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ134958Medicaid