Healthcare Provider Details

I. General information

NPI: 1558193391
Provider Name (Legal Business Name): OPEN MIND GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 N 90TH ST STE 750
SCOTTSDALE AZ
85260-2776
US

IV. Provider business mailing address

3333 E CAMELBACK RD STE 260
PHOENIX AZ
85018-2390
US

V. Phone/Fax

Practice location:
  • Phone: 480-565-6440
  • Fax:
Mailing address:
  • Phone: 602-698-4938
  • Fax: 703-202-9185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANK JOSEPH GENOVA
Title or Position: OWNER
Credential: MD
Phone: 602-698-4938