Healthcare Provider Details

I. General information

NPI: 1063900835
Provider Name (Legal Business Name): ARIZONA TMS THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 N 16TH ST STE 201
PHOENIX AZ
85016-5161
US

IV. Provider business mailing address

4602 N 16TH ST STE 201
PHOENIX AZ
85016-5161
US

V. Phone/Fax

Practice location:
  • Phone: 602-791-1834
  • Fax: 602-795-2608
Mailing address:
  • Phone: 602-791-1834
  • Fax: 602-795-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25986
License Number StateAZ

VIII. Authorized Official

Name: DR. LEE ANN KELLEY
Title or Position: PRESIDENT
Credential: MD
Phone: 602-795-1834