# ID SUBSTRATE, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043930662
- **Authorized official:** MRS. DAWN M CRAIG (ADMINISTRATOR)
- **Authorized official phone:** (602) 561-7806

## Contact information

- **Practice address:** 4500 N 32ND ST STE 100A, PHOENIX, AZ 85018-3360
- **Practice address phone:** (602) 200-8690
- **Practice address fax:** (602) 264-8107
- **Mailing address:** PO BOX 10044, PHOENIX, AZ 85064-0044
- **Mailing address phone:** (602) 405-4622
- **Mailing address fax:** (602) 264-8107

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 103TF0200X | Forensic Psychologist | — | NULL | — |
| 103TF0200X | Forensic Psychologist | — | — | — |
| 103TP2701X | Group Psychotherapy Psychologist | — | NULL | — |
| 103TP2701X | Group Psychotherapy Psychologist | — | — | — |

## Other

- **Enumeration date:** 09/01/2022
- **Last updated:** 09/01/2022