| Supreme Positive Innovation Services Llc | |
|
1833 W Main St Ste 139-140 Mesa AZ 85201-6922 | |
| (602) 757-6786 | |
| Not Available |
| Full Name | Supreme Positive Innovation Services Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1833 W Main St Ste 139-140, Mesa, Arizona |
| Authorized Official Name and Position | Katelyn Tamas (OWNER) |
| Authorized Official Contact | 6027576786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Supreme Positive Innovation Services Llc 1833 W Main St Ste 139-140 Mesa AZ 85201-6922 Ph: () - | Supreme Positive Innovation Services Llc 1833 W Main St Ste 139-140 Mesa AZ 85201-6922 Ph: (602) 757-6786 |
| NPI Number | 1003401902 |
|---|---|
| Provider Enumeration Date | 03/03/2021 |
| Last Update Date | 03/03/2021 |
| Certification Date | 03/03/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003401902 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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