Organization
GOING THE EXTRA MILE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RALPH LOPEZ (BHT/CO-OWNER)
(480) 799-6693
Entity
Organization
Contact information
Practice address
1102 W MCDOWELL RD, PHOENIX, AZ 85007-1700
(602) 612-2436
Mailing address
1102 W MCDOWELL RD, PHOENIX, AZ 85007-1700
(602) 612-2436
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
106S00000X
Behavior Technician
—
—
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
07/11/2021
Last updated
07/19/2021
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