Healthcare Provider Details

I. General information

NPI: 1144196171
Provider Name (Legal Business Name): GROVE COMPREHENSIVE PSYCHIATRY AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 E SUPERSTITION SPRINGS BLVD STE 224
MESA AZ
85206-4394
US

IV. Provider business mailing address

6402 E SUPERSTITION SPRINGS BLVD STE 224
MESA AZ
85206-4394
US

V. Phone/Fax

Practice location:
  • Phone: 480-470-3442
  • Fax:
Mailing address:
  • Phone: 480-470-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIGHAM JOHN NICOLL
Title or Position: PARTNER
Credential: MD
Phone: 480-272-1099