NPIMap

Organization Active NPI

Desert Sage Health PLLC

Doing business as West Valley Family Development Center

  • Psychologist
  • Goodyear, AZ
National Provider Identifier
1891201521
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
DESERT SAGE HEALTH PLLC
Doing business as
West Valley Family Development Center
Practice address
2620 N 140TH Ave
Ste 101
Goodyear, AZ 85395-2437
Phone
(623) 536-7956
Fax
(623) 536-9806
NPI assigned
Dec 18, 2017
Last updated
Jun 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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

Authorized official

Name
Dr. Stefanie M Kool, PSY DNPI 1629386289
Title
Owner
Phone
(623) 536-7956

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X Primary

Addresses

Primary practice location

2620 N 140TH Ave
Ste 101
Goodyear, AZ 85395-2437

Mailing address

2620 N 140TH Ave
Ste 101
Goodyear, AZ 85395-2437
Phone (623) 536-7956

Other names 1

  • West Valley Family Development Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180129001056 AZ Part B Supplier - Clinic/Group Practice 7416217153 Receives reassigned benefits from 12 practitioners
Practice locations: Goodyear, AZ

National Provider Directory

National Provider Directory

Locations

3400 N Dysart Rd
Avondale, AZ 85392

2620 N 140th Ave
#101
Goodyear, AZ 85395
Phone (623) 536-7956

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1513555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717459200000",
    "number": "1891201521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 N 140TH AVE",
            "address_2": "STE 101",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952437",
            "telephone_number": "623-536-7956",
            "fax_number": "623-536-9806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 N 140TH AVE",
            "address_2": "STE 101",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952437",
            "telephone_number": "623-536-7956",
            "fax_number": "623-536-9806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT SAGE HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-18",
        "last_updated": "2024-06-04",
        "status": "A",
        "authorized_official_last_name": "KOOL",
        "authorized_official_first_name": "STEFANIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-536-7956",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY D"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Valley Family Development Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.