Healthcare Provider Details

I. General information

NPI: 1942173646
Provider Name (Legal Business Name): AZT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18456 N 25TH AVE
PHOENIX AZ
85023-1213
US

IV. Provider business mailing address

6635 W HAPPY VALLEY RD STE A104
GLENDALE AZ
85310-2609
US

V. Phone/Fax

Practice location:
  • Phone: 480-219-7098
  • Fax:
Mailing address:
  • Phone: 480-219-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BRIAN CARLISLE
Title or Position: MANAGER
Credential: FNP-C
Phone: 480-219-7098