Testimony Behavioral Health Residential LLC

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

TESTIMONY BEHAVIORAL HEALTH RESIDENTIAL LLC

Doing business as

Testimony Behavioral Health Residential LLC

Practice address

1110 E Glenn Dr
Phoenix, AZ 85020-5347

Phone

(623) 383-3759

NPI assigned

May 20, 2024

Organization subpart

No

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

Authorized official

Name

Mojama Fatoma

Title

Ceo/Owner

Phone

(623) 383-3759

Specialties & licenses 1

Addresses

Other names 1

• Testimony Behavioral Health Residential LLC Doing business as

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

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716163200000",
    "number": "1427897438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11770 W DAVIS LN",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853237695",
            "telephone_number": "623-383-3759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 E GLENN DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850205347",
            "telephone_number": "623-383-3759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TESTIMONY BEHAVIORAL HEALTH RESIDENTIAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-20",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-13",
        "status": "A",
        "authorized_official_last_name": "FATOMA",
        "authorized_official_first_name": "MOJAMA",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "623-383-3759"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Testimony Behavioral Health Residential LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John R Tesser, MD
• Michelle Tesser, FNP-C
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• David Carmine Testa, M.D.
• Erin Testa, PH.D.
• Testlabs
• Kelly Teter
• Brianda I. Teterukov, LPC
• Joyce J Tetreault, FNP
• Debbie Marie Tew, OTR/L, CLT-LANA

• Developmental Disabilities Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Developmental Disabilities Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; 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.