Healthcare Provider Details

I. General information

NPI: 1174449631
Provider Name (Legal Business Name): INDY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 N 31ST AVE STE 109
PHOENIX AZ
85051-9564
US

IV. Provider business mailing address

10240 N 31ST AVE STE 109
PHOENIX AZ
85051-9564
US

V. Phone/Fax

Practice location:
  • Phone: 480-647-2279
  • Fax:
Mailing address:
  • Phone: 480-647-2279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER GODLEY
Title or Position: OWNER
Credential: PMHNP
Phone: 480-647-2279