Organization
TRACK HOUSE LIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA ROBERSON LCSW (PRESIDENT)
(602) 522-2595
Entity
Organization
Contact information
Practice address
4205 N 7TH AVE STE 307, PHOENIX, AZ 85013
(602) 522-2595
(602) 258-4996
Mailing address
4205 N 7TH AVE STE 307, PHOENIX, AZ 85013-3080
(602) 522-2595
(602) 258-4996
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
CLSG7622
AZ
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
01/17/2007
Last updated
06/19/2018
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