Healthcare Provider Details

I. General information

NPI: 1922522242
Provider Name (Legal Business Name): TREE OF LIFE MENTAL HEALTH SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 W. VIRGINIA #1138
PHOENIX AZ
85037
US

IV. Provider business mailing address

8400 W VIRGINIA AVE APT 1138
PHOENIX AZ
85037-8370
US

V. Phone/Fax

Practice location:
  • Phone: 702-981-1153
  • Fax: 702-974-4555
Mailing address:
  • Phone: 702-981-1153
  • Fax: 702-974-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. BRENTON KENDYLE HENDERSON
Title or Position: CO-OWNER
Credential:
Phone: 702-981-1153