MEDICARE: 180 MENTAL HEALTH AND WELLNESS, LLC.

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1710663430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	180 MENTAL HEALTH AND WELLNESS, LLC.

Provider Business Mailing Address
First Line	:	9855 E SOUTHERN AVE # 50729
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85209-3801
Country	:	US
Telephone Number	:	480-721-7055
Fax Number	:

Provider Business Practice Location Address
First Line	:	3404 W CHERYL DR STE A150
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9615
Country	:	US
Telephone Number	:	480-863-5250
Fax Number	:	480-896-2254

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ANGELA STUFF
Credential	:	FNP, PMHNP
Telephone Number	:	480-721-7055

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	01/23/2024

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