Healthcare Provider Details

I. General information

NPI: 1598291304
Provider Name (Legal Business Name): PINKHEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12725 W INDIAN SCHOOL RD SUITE E 101
AVONDALE AZ
85392-9520
US

IV. Provider business mailing address

12725 W INDIAN SCHOOL RD SUITE E 101
AVONDALE AZ
85392-9520
US

V. Phone/Fax

Practice location:
  • Phone: 480-442-3834
  • Fax: 623-243-5751
Mailing address:
  • Phone: 480-442-3834
  • Fax: 623-243-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3312
License Number StateAZ

VIII. Authorized Official

Name: DR. ERICA K KING
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 480-442-3834