Healthcare Provider Details

I. General information

NPI: 1932986205
Provider Name (Legal Business Name): NEW DESTINY HEALING ARTS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 RAMAR RD
BULLHEAD CITY AZ
86442-6010
US

IV. Provider business mailing address

8205 S PRIEST DR UNIT 12451
TEMPE AZ
85284-0175
US

V. Phone/Fax

Practice location:
  • Phone: 480-395-0233
  • Fax:
Mailing address:
  • Phone:
  • 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 Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHARLI BERRY
Title or Position: CCO
Credential: LPC
Phone: 602-770-2055