Healthcare Provider Details

I. General information

NPI: 1730014689
Provider Name (Legal Business Name): SOUTHWEST MIND INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE STE 140
PHOENIX AZ
85013-3449
US

IV. Provider business mailing address

743 W MCLELLAN BLVD
PHOENIX AZ
85013-1032
US

V. Phone/Fax

Practice location:
  • Phone: 623-396-6822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NICOLE WEANT
Title or Position: OWNER/DIRECTOR
Credential: LCSW
Phone: 917-900-6623