MEDICARE: MENTALLY ILL KIDS IN DISTRESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	BH4218	AZ

General Provider Information

NPI Number	:	1306281233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTALLY ILL KIDS IN DISTRESS

Provider Business Mailing Address
First Line	:	7816 N 19TH AVE STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-7036
Country	:	US
Telephone Number	:	602-253-1240
Fax Number	:

Provider Business Practice Location Address
First Line	:	7816 N 19TH AVE STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-7036
Country	:	US
Telephone Number	:	602-253-1240
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. MATT AUNA
Credential	:	BHT
Telephone Number	:	602-253-1240

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	12/05/2025

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