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General NPI Number Information
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NPI Number | 1013645712
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Entity Type | Organization
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Legal Business Name | SERENE WELLNESS CENTER LLC
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 10000 N 31ST AVE STE D304B
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City | PHOENIX
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State | AZ
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Zip | 85051-9582
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Country | US
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Telephone | 623-323-2448
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Fax | 623-666-6348
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Provider Business Mailing Address
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Address Line | 544 S 172ND AVE
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City | GOODYEAR
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State | AZ
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Zip | 85338-1281
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COURTNEY TAFOYA
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Credential | PMHNP
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Telephone | 623-323-2448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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