Healthcare Provider Details

I. General information

NPI: 1568268183
Provider Name (Legal Business Name): EVERWELL MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 N 91ST ST STE A115
SCOTTSDALE AZ
85258-5036
US

IV. Provider business mailing address

9700 N 91ST ST STE A115
SCOTTSDALE AZ
85258-5036
US

V. Phone/Fax

Practice location:
  • Phone: 623-283-2057
  • Fax: 623-401-7108
Mailing address:
  • Phone: 623-283-2057
  • Fax: 623-401-7108

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: BRIAN CLUKIE
Title or Position: ADMINISTRATOR
Credential:
Phone: 813-997-2099