Provider Demographics
NPI:1336224336
Name:ADVENTURE DISCOVERY INC
Entity type:Organization
Organization Name:ADVENTURE DISCOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:928-774-1926
Mailing Address - Street 1:403 W BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4467
Mailing Address - Country:US
Mailing Address - Phone:928-774-1926
Mailing Address - Fax:928-779-4273
Practice Address - Street 1:403 W BIRCH AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4467
Practice Address - Country:US
Practice Address - Phone:928-774-1926
Practice Address - Fax:928-779-4273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-650251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ134536OtherPIN#