Provider Demographics
NPI:1386403053
Name:TEMPE TRAILS LLC
Entity type:Organization
Organization Name:TEMPE TRAILS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WEJROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MC, LPC
Authorized Official - Phone:480-747-8703
Mailing Address - Street 1:538 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6514
Mailing Address - Country:US
Mailing Address - Phone:480-747-8703
Mailing Address - Fax:
Practice Address - Street 1:538 W 17TH ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-6514
Practice Address - Country:US
Practice Address - Phone:480-747-8703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty