Healthcare Provider Details

I. General information

NPI: 1861300725
Provider Name (Legal Business Name): MICHELLE LINSSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEROME GILLIE

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 E CAMELBACK RD
PHOENIX AZ
85016-4502
US

IV. Provider business mailing address

3104 E CAMELBACK RD # 160
PHOENIX AZ
85016-4502
US

V. Phone/Fax

Practice location:
  • Phone: 480-395-9205
  • Fax:
Mailing address:
  • Phone: 480-395-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: