Healthcare Provider Details

I. General information

NPI: 1760371330
Provider Name (Legal Business Name): ARIZONA BEHAVIORAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 W GROVERS AVE
PHOENIX AZ
85023-6515
US

IV. Provider business mailing address

302 W MURIEL DR
PHOENIX AZ
85023-6524
US

V. Phone/Fax

Practice location:
  • Phone: 602-326-1180
  • Fax:
Mailing address:
  • Phone: 602-326-1180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. ELANA LEAH MASTOV
Title or Position: OWNER/PROVIDER
Credential:
Phone: 602-326-1180