NPIMap

Organization Active NPI

Copper Canyon Academy

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Lake Montezuma, AZ
National Provider Identifier
1275978900
Registry record updated May 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
COPPER CANYON ACADEMY
Practice address
3095 Coronado Trail
Lake Montezuma, AZ 86335
Phone
(928) 567-1322
NPI assigned
May 8, 2013
Last updated
May 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2013

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

Authorized official

Name
Ariella Allaman, MA, LAC
Title
Therapist
Phone
(928) 567-1322

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X NU Primary

Addresses

Primary practice location

3095 Coronado Trail
Lake Montezuma, AZ 86335

Mailing address

PO Box 230
Rimrock, AZ 86335-0230
Phone (928) 567-1322

Other identifiers 1

IdentifierTypeStateIssuer
LAC-13769OtherAZAZ BOARD OF BEHAVIORAL HEALTH EXAMINERS

National Provider Directory

National Provider Directory
Tax ID family
Copper Canyon Academy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1367971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368662400000",
    "number": "1275978900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 230",
            "city": "RIMROCK",
            "state": "AZ",
            "postal_code": "863350230",
            "telephone_number": "928-567-1322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3095 CORONADO TRAIL",
            "city": "LAKE MONTEZUMA",
            "state": "AZ",
            "postal_code": "86335",
            "telephone_number": "928-567-1322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPPER CANYON ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-08",
        "last_updated": "2013-05-16",
        "status": "A",
        "authorized_official_last_name": "ALLAMAN",
        "authorized_official_first_name": "ARIELLA",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "928-567-1322",
        "authorized_official_credential": "MA, LAC"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ BOARD OF BEHAVIORAL HEALTH EXAMINERS",
            "identifier": "LAC-13769",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Montezuma, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2013; 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.