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General NPI Number Information
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NPI Number | 1124486469
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Entity Type | Organization
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Legal Business Name | STRATUM MENTAL HEALTH OF ARIZONA INC
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Dates
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Enumeration Date | 02/01/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 3104 E CAMELBACK RD #2031
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City | PHOENIX
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State | AZ
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Zip | 85016-4502
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Country | US
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Telephone | 855-578-7288
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Fax | 888-741-7967
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Provider Business Mailing Address
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Address Line | 40335 WINCHESTER RD # E221
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City | TEMECULA
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State | CA
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Zip | 92591-5500
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Country | US
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Telephone | 855-578-7288
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Fax | 888-741-7967
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Authorized Official
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Title or Position | OWNER
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Name | MALCOLM ORLANDO GREYSON
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Credential |
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Telephone | 855-578-7288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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