Healthcare Provider Details

I. General information

NPI: 1487514485
Provider Name (Legal Business Name): MINDHAVEN PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1166 E WARNER RD STE 206
GILBERT AZ
85296-3066
US

IV. Provider business mailing address

2942 N 24TH ST STE 115
PHOENIX AZ
85016-7849
US

V. Phone/Fax

Practice location:
  • Phone: 480-269-4469
  • Fax:
Mailing address:
  • Phone: 480-269-4469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. SOPHIA JOLLY
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 480-269-4469