Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Canyon Repose LLC

Organization Addiction (Substance Use Disorder) Counselor · NPI 1376420596

Canyon Repose LLC is an Addiction (Substance Use Disorder) Counselor in Phoenix, Arizona. Registered with an NPI since 2025.

In the registry since
2025
Specialties on file
6
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

8102 N 23rd Ave Ste B
Phoenix, AZ 85021-4962
Phone: (602) 326-1828
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X
Case Manager/Care Coordinator Taxonomy 171M00000X
Internal Medicine Physician Taxonomy 207R00000X
Addiction Medicine (Internal Medicine) Physician Taxonomy 207RA0401X
Primary Care Nurse Practitioner Taxonomy 363LP2300X

Record details

NPI number1376420596
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jerry Maroney — Director · (602) 326-1828
NPI enumeratedAugust 19, 2025
Last updated in NPPESSeptember 12, 2025
Certification dateSeptember 12, 2025
Mailing address205 E Osborn Rd # 101, Phoenix, AZ 85012-2327

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