# ID SUBSTRATE, PLLC

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

## Provider details

- **NPI number:** 1588387005
- **Authorized official:** FLYN HAYES MS FOR PSY LISAC (HEALTH CARE PROVIDER)
- **Authorized official phone:** (602) 405-4622

## Contact information

- **Practice address:** 4500 N. 32ND STREET, 100-A, PHOENIX, AZ 85018-3033
- **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 |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 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:** 09/20/2022
- **Last updated:** 09/20/2022