Healthcare Provider Details

I. General information

NPI: 1902739428
Provider Name (Legal Business Name): AZ MENTAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2462 N PARK AVE
TUCSON AZ
85719-3035
US

IV. Provider business mailing address

2462 N PARK AVE
TUCSON AZ
85719-3035
US

V. Phone/Fax

Practice location:
  • Phone: 520-334-9080
  • Fax: 949-909-8122
Mailing address:
  • Phone: 520-334-9080
  • Fax: 949-909-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY GRAY
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 520-334-9080