Provider Demographics
NPI:1992120885
Name:ANIMALS FACILITATING ADOLESCENTS AND CHILDREN THERAPEUTICALLY, INC.
Entity type:Organization
Organization Name:ANIMALS FACILITATING ADOLESCENTS AND CHILDREN THERAPEUTICALLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DORI
Authorized Official - Middle Name:SUZAN
Authorized Official - Last Name:TAMAGNI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LISAC
Authorized Official - Phone:520-400-9444
Mailing Address - Street 1:39213 S WILD HARDT WAY STE A
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-8396
Mailing Address - Country:US
Mailing Address - Phone:520-400-9444
Mailing Address - Fax:520-879-6180
Practice Address - Street 1:39213 S WILD HARDT WAY STE A
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-8396
Practice Address - Country:US
Practice Address - Phone:520-400-9444
Practice Address - Fax:520-879-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-4395322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children