Healthcare Provider Details

I. General information

NPI: 1366968125
Provider Name (Legal Business Name): SCOTTSDALE MENTAL HEALTH AND WELLNESS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 E RAINTREE DR STE 130
SCOTTSDALE AZ
85260-2692
US

IV. Provider business mailing address

8350 E RAINTREE DR STE 130
SCOTTSDALE AZ
85260-2692
US

V. Phone/Fax

Practice location:
  • Phone: 480-508-0882
  • Fax: 480-508-0891
Mailing address:
  • Phone: 480-508-0882
  • Fax: 480-508-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: EHAB ABDALLAH
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 602-999-9765