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General NPI Number Information
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NPI Number | 1174201941
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Entity Type | Organization
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Legal Business Name | CEREBELLUM MENTAL HEALTH CLINIC, LLC
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 507 W COMSTOCK DR
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City | GILBERT
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State | AZ
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Zip | 85233-5803
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Country | US
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Telephone | 602-626-4708
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Fax |
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Provider Business Mailing Address
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Address Line | 2473 S HIGLEY RD STE 104
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City | GILBERT
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State | AZ
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Zip | 85295-1103
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Country | US
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Telephone | 602-626-4708
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC NP
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Name | JALILI ARABI
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Credential | PMHNP-BC
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Telephone | 602-626-4708
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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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