Healthcare Provider Details

I. General information

NPI: 1134992738
Provider Name (Legal Business Name): WOODWARD PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/11/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14845 N MAYFLOWER DR
FOUNTAIN HILLS AZ
85268-2248
US

IV. Provider business mailing address

14845 N MAYFLOWER DR
FOUNTAIN HILLS AZ
85268-2248
US

V. Phone/Fax

Practice location:
  • Phone: 480-272-2579
  • Fax:
Mailing address:
  • Phone: 480-272-2579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN SEAN WOODWARD
Title or Position: MEMBER/MANAGER/ORGANIZER
Credential: PMHNP-BC
Phone: 480-272-2579