Third Eye Integration, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

THIRD EYE INTEGRATION, LLC

Practice address

18631 N 19TH Ave Ste 158305
Phoenix, AZ 85027-0408

Phone

(623) 986-3987

NPI assigned

Jan 31, 2019

Organization subpart

No

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

Authorized official

Name

Ms. Wendy Yvonne Shepherd, MA, CCTP

Title

Owner

Phone

(623) 986-3987

Specialties & licenses 1

Addresses

Other names 1

• Third Eye Integration Doing business as

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

{
    "created_epoch": "1548892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567987200000",
    "number": "1629533906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18631 N 19TH AVE STE 158305",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850270408",
            "telephone_number": "623-986-3987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18631 N 19TH AVE STE 158305",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850270408",
            "telephone_number": "623-986-3987"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20012 N 18th Dr",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850274248",
            "country_code": "US",
            "telephone_number": "623-986-3987",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THIRD EYE INTEGRATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-31",
        "last_updated": "2019-09-09",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "YVONNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-986-3987",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA, CCTP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Third Eye Integration",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Third Eye Integration",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2019; 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.