Healthcare Provider Details

I. General information

NPI: 1073209318
Provider Name (Legal Business Name): DREAM LAND MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S LITCHFIELD RD
GOODYEAR AZ
85338-1513
US

IV. Provider business mailing address

16365 W BADEN AVE
GOODYEAR AZ
85338-6269
US

V. Phone/Fax

Practice location:
  • Phone: 602-529-0706
  • Fax:
Mailing address:
  • Phone: 602-529-0706
  • 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 State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: HAMZA PAULSON
Title or Position: OWNER
Credential:
Phone: 602-592-0706