Healthcare Provider Details

I. General information

NPI: 1417876350
Provider Name (Legal Business Name): ESSENTIAL MIND THERAPEUTIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 W CAMELBACK RD UNIT 1076
PHOENIX AZ
85037-5051
US

IV. Provider business mailing address

9920 W CAMELBACK RD UNIT 1076
PHOENIX AZ
85037-5051
US

V. Phone/Fax

Practice location:
  • Phone: 623-694-9290
  • Fax:
Mailing address:
  • Phone: 623-694-9290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHLISA MARIE EVANS
Title or Position: OWNER
Credential: LPC
Phone: 623-694-9290