Organization · Type 2 NPI
Canyon Repose LLC
Mental Health Counselor · Phoenix, AZ
NPI number
1376420596
Active
Practice location
8102 N 23rd Ave Ste B
Phoenix, AZ 85021-4962
Mailing address
205 E Osborn Rd # 101
Phoenix, AZ 85012-2327
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | None listed |
| Mental Health Counselor Primary | 101YM0800X | None listed |
| Case Manager/Care Coordinator | 171M00000X | None listed |
| Internal Medicine Physician | 207R00000X | None listed |
| Addiction Medicine (Internal Medicine) Physician | 207RA0401X | None listed |
| Primary Care Nurse Practitioner | 363LP2300X | None listed |
Mental Health Counselor: Definition to come...
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About NPI 1376420596
Canyon Repose LLC's National Provider Identifier is 1376420596, issued on Aug 19, 2025. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Phoenix, AZ. The record was last updated on Sep 12, 2025.