Aj Southwest Ventures Inc
Organization Active NPI Marriage & Family Therapist · Tempe, AZ
NPI 1639880917 · NPPES record last updated Feb 18, 2025
Key facts
- NPI
- 1639880917
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- Legal business name
- AJ SOUTHWEST VENTURES INC
- Practice address
- 3920 S Rural Rd Ste 112
Tempe, AZ 85282-5500 - Phone
- (480) 674-9220
- Fax
- (674) 480-9231
- NPI assigned
- Dec 8, 2022
- Organization subpart
- No
Authorized official
- Name
- Allyson Fernstrom, MSW
- Title
- Owner
- Phone
- (602) 502-3806
Corporate family (same tax ID) 1
Practitioners 14
-
Abby Bailly, MSW, LCSW
-
Ashley Franchetto, LPC
-
Paul K. Gibson, MC, LMFT
-
Deborah Kovaleski, MA, LPC
-
Lee Ann Weiler, MA, LPC
-
Linda Weiss, MA, LPC
-
Lillian Huili Foster, DNP,NP-C,PMHNP-C
-
Jeffrey Ray Fulkerson, M ED, MS, LAC, LPC
-
David Bryan Tanis, DNP, PMHNP-BC
-
Rianna Charlene Travaglini, LAMFT
-
Michelle Reijonen, PMHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240117001778 | AZ | Part B Supplier - Clinic/Group Practice | 8224480090 |
Receives reassigned benefits from 12 practitioners Practice locations: Tempe, AZ |
National Provider Directory
- Tax ID family
- Aj Southwest Ventures Dba Ellie Mental Health
Locations
3920 S Rural Rd
Ste 112
Tempe, AZ 85282
Phone (480) 428-2944
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist |
106H00000X | Yes | ||
| Psychiatry Physician |
2084P0800X |
Addresses
Primary practice location
3920 S Rural Rd Ste 112
Tempe, AZ 85282-5500
Mailing address
3920 S Rural Rd Ste 112
Tempe, AZ 85282-5500
Phone (480) 674-9220
Other names
- reVIBE Mental Health
Other providers in Tempe, AZ
- Kimberly W Ahn
- Aid to Women Center
- Aim Enterprises Inc
- Aim Healthcare Providers, LLC
- Aj Southwest Ventures Inc
- Akers Enterprises, LLC
- M. Jamil Akhtar
- Pervaiz Akhter
- Olukemi Akinbusuyi
- Ginger D Akins
All providers in Tempe, AZ · Marriage & Family Therapist in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.