Healthcare Provider Details

I. General information

NPI: 1982545794
Provider Name (Legal Business Name): ENCHANTED SKY FAMILY PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44480 W HONEYCUTT RD STE 103
MARICOPA AZ
85138-2909
US

IV. Provider business mailing address

44480 W HONEYCUTT RD STE 103
MARICOPA AZ
85138-2909
US

V. Phone/Fax

Practice location:
  • Phone: 520-980-9251
  • Fax: 520-667-2397
Mailing address:
  • Phone: 520-980-9251
  • Fax: 520-667-2397

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: MRS. JENNIFER L GREEN
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 520-980-9251