Provider Demographics
NPI:1063621365
Name:NEUROLOGIC MUSIC THERAPY SERVICES OF ARIZONA
Entity type:Organization
Organization Name:NEUROLOGIC MUSIC THERAPY SERVICES OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC, NMT FELLOW
Authorized Official - Phone:602-840-6410
Mailing Address - Street 1:2702 N 3RD ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1130
Mailing Address - Country:US
Mailing Address - Phone:602-840-6410
Mailing Address - Fax:602-840-6431
Practice Address - Street 1:2702 N 3RD ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1130
Practice Address - Country:US
Practice Address - Phone:602-840-6410
Practice Address - Fax:602-840-6431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ994039Medicaid