Healthcare Provider Details

I. General information

NPI: 1043061187
Provider Name (Legal Business Name): OWN YOUR PATH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 N DYSART RD STE 3
GOODYEAR AZ
85395-1116
US

IV. Provider business mailing address

12350 W CAMELBACK RD UNIT 70
LITCHFIELD PARK AZ
85340-5634
US

V. Phone/Fax

Practice location:
  • Phone: 623-256-2136
  • Fax:
Mailing address:
  • Phone: 623-256-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. PARIS CHRISTA MANDY
Title or Position: OWNER
Credential: NP
Phone: 623-256-2136