NPIMap

Organization Active NPI

Stonewall Institute, LLC

  • Community/Behavioral Health Agency
  • Phoenix, AZ
National Provider Identifier
1972838167
Registry record updated Jul 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
BH3856 Issued in AZ
Legal business name
STONEWALL INSTITUTE, LLC
Practice address
4020 N 20TH St Ste 302
Phoenix, AZ 85016-6032
Phone
(602) 535-6468
NPI assigned
Oct 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2012

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

Authorized official

Name
Mr. Kyle Jamison Penniman, MSW, LISACNPI 1922267079
Title
Ceo
Phone
(602) 535-6468

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
Community/Behavioral Health Agency 251S00000X BH3856 AZ Primary

Addresses

Primary practice location

4020 N 20TH St Ste 302
Phoenix, AZ 85016-6032

Mailing address

4020 N 20TH St Ste 302
Phoenix, AZ 85016-6032
Phone (602) 535-6468

National Provider Directory

National Provider Directory

Locations

4020 N 20th St
Ste 302
Phoenix, AZ 85016
Phone (602) 535-6468

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1254787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343347200000",
    "number": "1972838167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 N 20TH ST STE 302",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850166032",
            "telephone_number": "602-535-6468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 N 20TH ST STE 302",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850166032",
            "telephone_number": "602-535-6468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONEWALL INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-06",
        "last_updated": "2012-07-27",
        "status": "A",
        "authorized_official_last_name": "PENNIMAN",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "JAMISON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-535-6468",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW, LISAC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "BH3856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2012; 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.