Provider Demographics
NPI:1811776271
Name:VR PSYCH SERVICES LLC
Entity type:Organization
Organization Name:VR PSYCH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BLAKES
Authorized Official - Suffix:JR
Authorized Official - Credentials:LISAC
Authorized Official - Phone:480-521-5289
Mailing Address - Street 1:1900 W CARLA VISTA DR UNIT 6665
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-4028
Mailing Address - Country:US
Mailing Address - Phone:480-521-5289
Mailing Address - Fax:
Practice Address - Street 1:1900 W CARLA VISTA DR UNIT 6665
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85246-4028
Practice Address - Country:US
Practice Address - Phone:480-521-5289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty