Healthcare Provider Details

I. General information

NPI: 1467374231
Provider Name (Legal Business Name): VERMILLION SKIES MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 W CRYSTAL DR
GOLDEN VALLEY AZ
86413-9112
US

IV. Provider business mailing address

3980 W CRYSTAL DR
GOLDEN VALLEY AZ
86413-9112
US

V. Phone/Fax

Practice location:
  • Phone: 702-518-5714
  • Fax:
Mailing address:
  • Phone: 702-518-5714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANDREW BENJAMIN CANVASSER
Title or Position: OWNER/DIRECTOR
Credential: LCSW
Phone: 702-518-5714