Provider Demographics
NPI:1568286748
Name:SONORAN DESERT PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:SONORAN DESERT PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-770-4153
Mailing Address - Street 1:12740 E SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-3438
Mailing Address - Country:US
Mailing Address - Phone:602-610-6071
Mailing Address - Fax:
Practice Address - Street 1:15333 N PIMA RD STE 305
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2717
Practice Address - Country:US
Practice Address - Phone:602-610-6071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty