Healthcare Provider Details

I. General information

NPI: 1114790078
Provider Name (Legal Business Name): HAZELWOOD MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7514 E MONTEREY WAY STE 4
SCOTTSDALE AZ
85251-6900
US

IV. Provider business mailing address

7514 E MONTEREY WAY STE 4
SCOTTSDALE AZ
85251-6900
US

V. Phone/Fax

Practice location:
  • Phone: 480-209-2136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHYLLIA DIXON
Title or Position: OWNER, PMHNP
Credential: NURSE PRACTITIONER
Phone: 809-495-7004