Healthcare Provider Details

I. General information

NPI: 1710539614
Provider Name (Legal Business Name): NEWU BEHAVIORAL HEALTH & WELLNESS CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13540 W CAMINO DEL SOL STE 3
SUN CITY WEST AZ
85375-4435
US

IV. Provider business mailing address

13540 W CAMINO DEL SOL STE 3
SUN CITY WEST AZ
85375-4435
US

V. Phone/Fax

Practice location:
  • Phone: 623-584-8923
  • Fax: 844-628-1655
Mailing address:
  • Phone: 623-584-8923
  • Fax: 844-628-1655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAREN MARINOS
Title or Position: OFFICE MANAGER
Credential:
Phone: 623-584-8923