Provider Demographics
NPI:1497233126
Name:RAPPORT1ST LLC
Entity Type:Organization
Organization Name:RAPPORT1ST LLC
Other - Org Name:RP1
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADDAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:602-486-6581
Mailing Address - Street 1:2601 N 3RD ST STE 303
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1101
Mailing Address - Country:US
Mailing Address - Phone:602-486-6581
Mailing Address - Fax:602-368-5999
Practice Address - Street 1:2601 N 3RD ST STE 303
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1101
Practice Address - Country:US
Practice Address - Phone:602-486-6581
Practice Address - Fax:602-368-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty