Canyon Repose LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

CANYON REPOSE LLC

Practice address

8102 N 23Rd Ave Ste B
Phoenix, AZ 85021-4962

Phone

(602) 326-1828

NPI assigned

Aug 19, 2025

Organization subpart

No

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

Authorized official

Name

Jerry Maroney

Title

Director

Phone

(602) 326-1828

Specialties & licenses 6

Addresses

Locations

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

{
    "created_epoch": "1755561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757635200000",
    "number": "1376420596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 E OSBORN RD # 101",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122327",
            "telephone_number": "602-628-0601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8102 N 23RD AVE STE B",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850214962",
            "telephone_number": "602-326-1828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON REPOSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-19",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A",
        "authorized_official_last_name": "MARONEY",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "602-326-1828"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Canyon Midwifery LLC
• Canyon Midwifery LLC
• Canyon Pain Center LLC
• Canyon Pathology Group LTD
• Canyon Physicians II
• Canyon Sleep Neurology and Wellness Group, LLC
• Canyon Social Services
• Canyon Surgical Specialists Center LLC
• Canyon Vista Dentistry and Orthodontics,LLP
• Qing J Cao, MD

• 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 12, 2025; 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.