Organization
VR PSYCH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDDIE LEE BLAKES JR. LISAC (THERAPIST)
(480) 521-5289
Entity
Organization
Contact information
Practice address
1900 W CARLA VISTA DR UNIT 6665, CHANDLER, AZ 85246-4028
(480) 521-5289
Mailing address
1900 W CARLA VISTA DR UNIT 6665, CHANDLER, AZ 85246-4028
(480) 521-5289
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
09/25/2023
Last updated
09/25/2023
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