Provider Demographics
NPI:1255033684
Name:LOYALTY HOUSE LLC
Entity type:Organization
Organization Name:LOYALTY HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OVERSITE
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:316-209-7731
Mailing Address - Street 1:1626 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2203
Mailing Address - Country:US
Mailing Address - Phone:480-382-6196
Mailing Address - Fax:
Practice Address - Street 1:1626 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2203
Practice Address - Country:US
Practice Address - Phone:480-382-6196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty