Organization
INNOVATIVE THERAPEUTIC SERVICES
Active
Organization
INNOVATIVE THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GWYNETTH ELAINE KELLY DBH, LCSW (CLINICAL DIRECTOR)
(602) 320-7925
Entity
Organization
Contact information
Practice address
15600 N BLACK CANYON HWY STE C103, PHOENIX, AZ 85053-4055
(602) 320-7925
(877) 958-9033
Mailing address
15600 N BLACK CANYON HWY # C103, PHOENIX, AZ 85053-4055
(602) 320-7925
(877) 958-9033
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
04/26/2018
Last updated
05/04/2022
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