Healthcare Provider Details

I. General information

NPI: 1598692329
Provider Name (Legal Business Name): COPPER MOUNTAIN CLINIC-THATCHER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 N COLLEGE AVE SUITE 104
THATCHER AZ
85552
US

IV. Provider business mailing address

1600 S 20TH AVE
SAFFORD AZ
85546-4011
US

V. Phone/Fax

Practice location:
  • Phone: 928-348-3960
  • Fax: 844-665-7939
Mailing address:
  • Phone: 928-348-4000
  • Fax: 844-665-7939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN LOUISE WILLIAMS
Title or Position: VP & CHIEF FINANCIAL OFFICER
Credential:
Phone: 928-348-4060