Provider Demographics
NPI:1326608290
Name:AHWATUKEE PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:AHWATUKEE PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MYSTI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINWATER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:480-223-8263
Mailing Address - Street 1:11011 S 48TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1787
Mailing Address - Country:US
Mailing Address - Phone:480-223-8263
Mailing Address - Fax:
Practice Address - Street 1:11011 S 48TH ST STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1787
Practice Address - Country:US
Practice Address - Phone:480-223-8263
Practice Address - Fax:480-247-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty