Healthcare Provider Details

I. General information

NPI: 1811287097
Provider Name (Legal Business Name): LATEEF MENTAL WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2011
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 S 15TH DR
PHOENIX AZ
85041-6930
US

IV. Provider business mailing address

PO BOX 26249
PHOENIX AZ
85068-6249
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-5050
  • Fax: 623-847-4047
Mailing address:
  • Phone: 602-403-5050
  • Fax: 623-847-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberAP1782
License Number StateAZ

VIII. Authorized Official

Name: MS. MARYAM H LATEEF
Title or Position: PRESIDENT
Credential: MHNP
Phone: 602-403-5050