Healthcare Provider Details

I. General information

NPI: 1609799303
Provider Name (Legal Business Name): QUEEN PALM BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20212 N VALENCIA DR
MARICOPA AZ
85138-5488
US

IV. Provider business mailing address

20212 N VALENCIA DR
MARICOPA AZ
85138-5488
US

V. Phone/Fax

Practice location:
  • Phone: 602-456-0031
  • Fax:
Mailing address:
  • Phone: 602-456-0031
  • 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: KIMBERLY OWENS
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 414-737-1036