Healthcare Provider Details

I. General information

NPI: 1780509349
Provider Name (Legal Business Name): AZ BEHAVIORAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 S AARON
MESA AZ
85209-3786
US

IV. Provider business mailing address

PO BOX 25444
TEMPE AZ
85285-5444
US

V. Phone/Fax

Practice location:
  • Phone: 602-688-2191
  • Fax: 602-688-2191
Mailing address:
  • Phone: 602-688-2191
  • Fax: 602-688-2191

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: IHUOMA NWOKE
Title or Position: NURSE PRACTITIONER
Credential: PMHNP
Phone: 602-688-2191