Healthcare Provider Details

I. General information

NPI: 1316689524
Provider Name (Legal Business Name): MIND APPLE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42211 N 41ST DR STE A157
ANTHEM AZ
85086-3810
US

IV. Provider business mailing address

42211 N 41ST DR STE A157
ANTHEM AZ
85086-3810
US

V. Phone/Fax

Practice location:
  • Phone: 602-884-1831
  • Fax:
Mailing address:
  • Phone: 602-884-1831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH BRYANT
Title or Position: OWNER
Credential: APRN-RNP
Phone: 602-884-1831