Healthcare Provider Details

I. General information

NPI: 1366052870
Provider Name (Legal Business Name): NEW VISION BEHAVIORAL HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 N 46TH DR
PHOENIX AZ
85031-3705
US

IV. Provider business mailing address

4409 N 179TH DR
GOODYEAR AZ
85395-5201
US

V. Phone/Fax

Practice location:
  • Phone: 602-367-5345
  • Fax:
Mailing address:
  • Phone: 623-229-4755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE MASON
Title or Position: ADMINISTRATOR
Credential:
Phone: 623-229-4755