Healthcare Provider Details

I. General information

NPI: 1699578252
Provider Name (Legal Business Name): WILDFLOWER URGENT PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2025
Last Update Date: 03/29/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9002 N CENTRAL AVE
PHOENIX AZ
85020-2405
US

IV. Provider business mailing address

2375 E CAMELBACK RD STE 600
PHOENIX AZ
85016-3493
US

V. Phone/Fax

Practice location:
  • Phone: 623-227-9564
  • Fax: 623-321-6563
Mailing address:
  • Phone: 623-227-9564
  • Fax: 623-321-6563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: COURTNEY SMITH
Title or Position: OWNER
Credential:
Phone: 602-505-1621