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General NPI Number Information
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NPI Number | 1043900335
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Entity Type | Organization
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Legal Business Name | PHOENIX MENTAL HEALTH & WELLNESS, PLLC
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 5353 W DARTMOUTH AVE STE 400
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City | DENVER
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State | CO
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Zip | 80227-5517
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Country | US
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Telephone | 303-868-5436
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Fax |
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Provider Business Mailing Address
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Address Line | 11865 W TULANE DR
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City | MORRISON
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State | CO
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Zip | 80465-1179
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Country | US
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Telephone | 303-868-5436
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Fax |
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Authorized Official
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Title or Position | OWNER, PROVIDER
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Name | CAMIE L VASQUEZ
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Credential | PMHNP-BC
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Telephone | 303-868-5436
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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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