Healthcare Provider Details

I. General information

NPI: 1346707486
Provider Name (Legal Business Name): YOUNG MIND CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 E MOUNTAIN VIEW RD
PHOENIX AZ
85028-3901
US

IV. Provider business mailing address

3202 E MOUNTAIN VIEW RD
PHOENIX AZ
85028-3901
US

V. Phone/Fax

Practice location:
  • Phone: 602-237-6653
  • Fax: 602-957-3600
Mailing address:
  • Phone: 602-237-6653
  • Fax: 602-957-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA L WOOD
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 602-237-6653