Healthcare Provider Details

I. General information

NPI: 1760918254
Provider Name (Legal Business Name): FAITH SOLUTIONS TO MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E JEFFERSON ST
PHOENIX AZ
85034-2315
US

IV. Provider business mailing address

14050 N 83RD AVE STE 290
PEORIA AZ
85381-5650
US

V. Phone/Fax

Practice location:
  • Phone: 855-529-3764
  • Fax: 602-603-5984
Mailing address:
  • Phone: 602-529-6102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARITY ELIZABETH NORTHAN
Title or Position: OWNER
Credential: LPC
Phone: 602-529-6102