NPIMap

Organization Active NPI

Destiny Outpatient Services

  • Community/Behavioral Health Agency
  • Phoenix, AZ
National Provider Identifier
1336593045
Registry record updated Apr 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
OTC7551 Issued in AZ
Legal business name
DESTINY OUTPATIENT SERVICES
Practice address
5308 N 17TH Ave
Phoenix, AZ 85015-3035
Phone
(602) 249-6674
Fax
(602) 926-0590
NPI assigned
Apr 19, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2016

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

Authorized official

Name
Mrs. Kathleen Geor-Zell Bynum, LPC
Title
Executive Director
Phone
(602) 327-8375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X OTC7551 AZ Primary

Addresses

Primary practice location

5308 N 17TH Ave
Phoenix, AZ 85015-3035

Mailing address

5306 N 17TH Ave
Phoenix, AZ 85015-3035
Phone (602) 249-6674

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2133560Destiny Outpatient Services5308 N 17TH Ave, Phoenix, AZ 85015Certificate of waiverAug 30, 2026

National Provider Directory

National Provider Directory
Tax ID family
Destiny Sober Living II Carver Ranch6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1461024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461024000000",
    "number": "1336593045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5306 N 17TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850153035",
            "telephone_number": "602-249-6674",
            "fax_number": "602-926-0590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5308 N 17TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850153035",
            "telephone_number": "602-249-6674",
            "fax_number": "602-926-0590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY OUTPATIENT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-19",
        "last_updated": "2016-04-19",
        "status": "A",
        "authorized_official_last_name": "BYNUM",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "GEOR-ZELL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "602-327-8375",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "OTC7551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.