Healthcare Provider Details

I. General information

NPI: 1801325493
Provider Name (Legal Business Name): COMPREHENSIVE NEURO WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E MONTEREY WAY
PHOENIX AZ
85012-2619
US

IV. Provider business mailing address

9138 W CLARA LN
PEORIA AZ
85382-5206
US

V. Phone/Fax

Practice location:
  • Phone: 480-292-6664
  • Fax:
Mailing address:
  • Phone: 480-292-6664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4383
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4383
License Number StateAZ

VIII. Authorized Official

Name: DR. ERIN R. HONKE
Title or Position: OWNER
Credential: PSY.D.
Phone: 480-292-6664