Active NPI
Teen Out Reach Services
- Psychologist
- Mesa, AZ
National Provider Identifier
1982289062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Legal business name
- TEEN OUT REACH SERVICES
- Practice address
- 544 S 96TH PL
Mesa, AZ 85208-2512 - Phone
- (480) 696-0338
- NPI assigned
- Mar 10, 2021
- Organization subpart
- Yes
- Parent organization
- BANNER HEALTH
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Amanda Reane Johnson, MD
- Title
- Director
- Phone
- (480) 696-0338
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary | ||
| Critical Access Hospital | 282NC0060X |
Addresses
Primary practice location
544 S 96TH PL
Mesa, AZ 85208-2512
Mailing address
544 S 96TH PL Apt 2080
Mesa, AZ 85208-2512
Phone (480) 696-0338
Other practice location 1
1 Ashburton Pl
Boston, MA 02108-1518
Phone (480) 696-0338
Other practice location 2
5600 Fishers Ln
Rockville, MD 20852-1750
Phone (480) 696-0338
Other practice location 3
401 E High St
Charlottesville, VA 22902-5119
Phone (480) 696-0338
Other practice location 4
4600 N Wyandotte St
Kansas City, MO 64116-1518
Phone (480) 696-0338
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 282NC0060X | Medicaid | AZ |
Other names 1
- Teen Out Reach Services
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | amanda@mytors.org | Direct | Banner Health |
National Provider Directory
National Provider Directory- Part of
- M E Lee MD
Locations
1 Ashburton Pl
Boston, MA 02108
Phone (480) 696-0338
5600 Fishers Ln
Rockville, MD 20852
Phone (301) 443-0842
401 E High St
Charlottesville, VA 22902
Phone (480) 696-0338
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Behavior Analyst
- Mesa, AZ
- NPI 1184209298
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615334400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1622678400000",
"number": "1982289062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "544 S 96TH PL APT 2080",
"city": "MESA",
"state": "AZ",
"postal_code": "852082512",
"telephone_number": "480-696-0338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "544 S 96TH PL",
"city": "MESA",
"state": "AZ",
"postal_code": "852082512",
"telephone_number": "480-696-0338"
}
],
"practiceLocations": [
{
"address_1": "1 Ashburton Pl",
"address_purpose": "LOCATION",
"city": "Boston",
"state": "MA",
"postal_code": "021081518",
"country_code": "US",
"telephone_number": "480-696-0338",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5600 Fishers Ln",
"address_purpose": "LOCATION",
"city": "Rockville",
"state": "MD",
"postal_code": "208521750",
"country_code": "US",
"telephone_number": "480-696-0338",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "401 E High St",
"address_purpose": "LOCATION",
"city": "Charlottesville",
"state": "VA",
"postal_code": "229025119",
"country_code": "US",
"telephone_number": "480-696-0338",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4600 N Wyandotte St",
"address_purpose": "LOCATION",
"city": "Kansas City",
"state": "MO",
"postal_code": "641161518",
"country_code": "US",
"telephone_number": "480-696-0338",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "TEEN OUT REACH SERVICES",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BANNER HEALTH",
"enumeration_date": "2021-03-10",
"last_updated": "2021-06-03",
"certification_date": "2021-06-03",
"status": "A",
"authorized_official_last_name": "JOHNSON",
"authorized_official_first_name": "AMANDA",
"authorized_official_middle_name": "REANE",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "480-696-0338",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
},
{
"code": "282NC0060X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital, Critical Access",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "282NC0060X",
"state": "AZ"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "amanda@mytors.org",
"affiliation": "Y",
"endpointDescription": "direct email",
"affiliationName": "Banner Health",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "544 S 96th Pl",
"city": "Mesa",
"state": "AZ",
"country_code": "US",
"postal_code": "852082512",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Teen Out Reach Services",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.