Provider Demographics
NPI:1215528377
Name:STEP BY STEP MENTORING
Entity type:Organization
Organization Name:STEP BY STEP MENTORING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-547-7356
Mailing Address - Street 1:2210 N 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85035-5144
Mailing Address - Country:US
Mailing Address - Phone:480-547-7356
Mailing Address - Fax:
Practice Address - Street 1:2210 N 78TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-5144
Practice Address - Country:US
Practice Address - Phone:480-547-7356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEP BY STEP MENTORING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-01
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ19912911Medicaid
AZ19922211Medicaid