Id Substrate, PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

ID SUBSTRATE, PLLC

Practice address

4500 N 32ND St Ste 100a
Phoenix, AZ 85018-3360

Phone

(602) 200-8690

Fax

(602) 264-8107

NPI assigned

Sep 1, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Dawn M Craig

Title

Administrator

Phone

(602) 561-7806

Specialties & licenses 3

Addresses

Tax ID family

Id Substrate PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Id Substrate, PLLC

  • Mental Health Counselor
  • Phoenix, AZ
  • NPI 1588387005
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661990400000",
    "number": "1043930662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10044",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850640044",
            "telephone_number": "602-405-4622",
            "fax_number": "602-264-8107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 N 32ND ST STE 100A",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850183360",
            "telephone_number": "602-200-8690",
            "fax_number": "602-264-8107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ID SUBSTRATE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-01",
        "last_updated": "2022-09-01",
        "certification_date": "2022-08-29",
        "status": "A",
        "authorized_official_last_name": "CRAIG",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "602-561-7806",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Forensic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.