Provider Demographics
NPI:1821609413
Name:SONORAN LEARNING AND BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:SONORAN LEARNING AND BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-882-4238
Mailing Address - Street 1:34225 N 27TH DR BLDG 4B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6087
Mailing Address - Country:US
Mailing Address - Phone:602-882-4238
Mailing Address - Fax:
Practice Address - Street 1:34225 N 27TH DR BLDG 4B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6087
Practice Address - Country:US
Practice Address - Phone:602-882-4238
Practice Address - Fax:480-867-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1548789415OtherNPPES