Mind 247 Practice LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Phoenix, AZ. Organization (NPI-2).
NPI number1902472467
StatusActive
Last updated in NPPESOct 4, 2022
Details
- NPI
- 1902472467
- Entity type
- Organization (NPI-2)
- Legal business name
- Mind 247 Practice LLC
- Organization subpart
- No
- Enumeration date
- Jun 3, 2021
- Certification date
- Oct 4, 2022
- Last updated
- Oct 4, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Practice location
2728 N 24th StPhoenix, AZ 85008-1050
Phone 844-646-3247
Mailing address
1465 N Scottsdale Rd Ste 400Scottsdale, AZ 85257-3634
Phone 844-646-3247
Authorized official
Aisha Lynn Depriest
Director Of Credentialing
4803694008
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