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Organization

SCOTTSDALE PROVIDENCE RECOVERY CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DANIEL JOSEPH NICHOLS LCSW (CLINICAL DIRECTOR)
(480) 284-7440
Entity
Organization

Contact information

Practice address
8889 E VIA LINDA, SCOTTSDALE, AZ 85258-5420
(480) 284-7440
(480) 284-4178
Mailing address
8889 E VIA LINDA, SCOTTSDALE, AZ 85258-5420
(480) 284-7440
(480) 284-4178

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
BH4837
AZ
101YM0800X
Mental Health Counselor
BH4837
AZ
1041C0700X
Clinical Social Worker
BH4837
AZ
261QM0850X
Adult Mental Health Clinic/Center
BH4837
AZ
261QM1300X
Multi-Specialty Clinic/Center
BH4837
AZ
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
BH4837
AZ
320800000X
Mental Illness Community Based Residential Treatment Facility
BH4837
AZ
324500000X
Substance Abuse Rehabilitation Facility
BH4837
AZ

Other

Enumeration date
03/18/2016
Last updated
01/23/2020
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