Provider Demographics
NPI:1861921975
Name:TERRAS PLACE LLC
Entity type:Organization
Organization Name:TERRAS PLACE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGELSANG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-285-9696
Mailing Address - Street 1:2435 E SOUTHERN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7628
Mailing Address - Country:US
Mailing Address - Phone:855-483-7727
Mailing Address - Fax:
Practice Address - Street 1:2435 E SOUTHERN AVE STE 2
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7628
Practice Address - Country:US
Practice Address - Phone:855-483-7727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10882101Y00000X
AZ13529101YM0800X
AZ14092101YP2500X
AZ1960103TC1900X
AZ05471041C0700X
AZ108741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty