Provider Demographics
NPI:1477913952
Name:HASSAYAMPA CENTER FOR FAMILIES LLC
Entity Type:Organization
Organization Name:HASSAYAMPA CENTER FOR FAMILIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-449-0972
Mailing Address - Street 1:515 DESERT CANYON RD
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-3360
Mailing Address - Country:US
Mailing Address - Phone:203-449-0972
Mailing Address - Fax:480-383-6356
Practice Address - Street 1:510 W SAVAGE ST
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-2206
Practice Address - Country:US
Practice Address - Phone:203-449-0972
Practice Address - Fax:480-383-6356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-12968251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health