MEDICARE: MIKID, 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	CSA09ADHS0142 -2	AZ

General Provider Information

NPI Number	:	1801026539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIKID, MENTALLY ILL KIDS IN DISTRESS

Provider Business Mailing Address
First Line	:	2642 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-8202
Country	:	US
Telephone Number	:	602-253-1240
Fax Number	:	602-253-1250

Provider Business Practice Location Address
First Line	:	100 E 24TH ST
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-8619
Country	:	US
Telephone Number	:	928-726-2191
Fax Number	:	928-726-4052

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	VICKI L. JOHNSON
Credential	:
Telephone Number	:	602-253-1240

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	07/15/2009

Similar Medicare Providers

1215380969 — MR. WILLIAM BAUTISTA AMISTAD JR. FNP
Practice Location Address:

100 E 24TH ST STE 3A
YUMA, AZ
85364-8619

Practice Phone: 928-750-6410
Practice Fax: 928-750-6433

1639650898 — THE AMISTAD CLINIC, PLLC
Practice Location Address:

100 E 24TH ST STE 3A
YUMA, AZ
85364-8619

Practice Phone: 480-773-8569
Practice Fax:

1205518388 — ERIN ASHLEY LEWANDOWSKI LCSW
Practice Location Address:

281 W 24TH ST STE 135
YUMA, AZ
85364-8587

Practice Phone: 928-750-5190
Practice Fax:

1417327107 — HEALOGICS SPECIALTY PHYSICIANS OF ARIZONA LLC
Practice Location Address:

2460 S PARKVIEW LOOP STE 205
YUMA, AZ
85364-5358

Practice Phone: 928-336-2030
Practice Fax:

1891637120 — MADRID CHIROPRACTIC LLC
Practice Location Address:

2450 S 4TH AVE STE 108A
YUMA, AZ
85364-7234

Practice Phone: 928-655-2008
Practice Fax:

1558700716 — DR. NATHAN MATTHEW WNUK M.D.
Practice Location Address:

2400 S AVENUE A
YUMA, AZ
85364-7170

Practice Phone: 928-336-1759
Practice Fax: 928-336-1758

Directions to “MIKID, MENTALLY ILL KIDS IN DISTRESS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.