Healthcare Provider Details

I. General information

NPI: 1770317422
Provider Name (Legal Business Name): DESERT CANYON PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 S 48TH ST STE 101
PHOENIX AZ
85044-1787
US

IV. Provider business mailing address

5560 W GERONIMO ST
CHANDLER AZ
85226-4448
US

V. Phone/Fax

Practice location:
  • Phone: 602-730-9670
  • Fax: 480-864-9440
Mailing address:
  • Phone: 602-349-9546
  • Fax: 480-864-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. VENESSA JOAN THOMPSON
Title or Position: NURSE PRACTITIONER, OWNER
Credential: WHNP, PMHNP
Phone: 602-349-9546