Provider Demographics
NPI:1568628212
Name:YOGA PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:YOGA PSYCHOTHERAPY, PLLC
Other - Org Name:MINDFUL LIFE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-225-2630
Mailing Address - Street 1:15434 E JOJOBA LN
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-4148
Mailing Address - Country:US
Mailing Address - Phone:480-225-2630
Mailing Address - Fax:
Practice Address - Street 1:15434 E JOJOBA LN
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-4148
Practice Address - Country:US
Practice Address - Phone:480-225-2630
Practice Address - Fax:480-816-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-117661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ356082Medicaid
AZ1568628212Medicare UPIN