Healthcare Provider Details

I. General information

NPI: 1033039698
Provider Name (Legal Business Name): MII GROUND BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 N 19TH AVE STE 235
PHOENIX AZ
85015-2459
US

IV. Provider business mailing address

532 SAINT SAMBAR DR
ELLENWOOD GA
30294-2995
US

V. Phone/Fax

Practice location:
  • Phone: 602-806-8356
  • Fax: 480-264-2655
Mailing address:
  • Phone: 414-702-8766
  • Fax: 480-264-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LATRONDA JONES
Title or Position: CEO
Credential:
Phone: 414-702-8766