Healthcare Provider Details

I. General information

NPI: 1609334812
Provider Name (Legal Business Name): JUST 1 LIFE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E MAIN ST STE 223
MESA AZ
85203-9074
US

IV. Provider business mailing address

1616 E MAIN ST STE 223
MESA AZ
85203-9074
US

V. Phone/Fax

Practice location:
  • Phone: 480-477-9199
  • Fax: 480-477-9199
Mailing address:
  • Phone: 480-477-9199
  • Fax: 480-477-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ERICA HOWARD
Title or Position: CFO
Credential:
Phone: 480-477-9199