Healthcare Provider Details

I. General information

NPI: 1750957247
Provider Name (Legal Business Name): CHOULET PERFORMANCE SCOTTSDALE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7377 E DOUBLETREE RANCH RD STE A-185
SCOTTSDALE AZ
85258-2053
US

IV. Provider business mailing address

7377 E DOUBLETREE RANCH RD STE A-185
SCOTTSDALE AZ
85258-2053
US

V. Phone/Fax

Practice location:
  • Phone: 480-448-6571
  • Fax: 480-612-8985
Mailing address:
  • Phone: 480-448-6571
  • Fax: 480-612-8985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BROOK CHOULET
Title or Position: MEMBER/FOUNDER
Credential: MD
Phone: 480-370-5656