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General NPI Number Information
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NPI Number | 1275488082
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Entity Type | Organization
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Legal Business Name | CANYON HAVEN PSYCHIATRY LLC
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Dates
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Enumeration Date | 02/27/2026
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Last Update Date | 02/27/2026
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Provider Practice Location Address
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Address Line | 6120 W BELL RD STE 100A
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City | GLENDALE
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State | AZ
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Zip | 85308-3780
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Country | US
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Telephone | 480-999-5114
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Fax | 480-459-3339
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Provider Business Mailing Address
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Address Line | 6120 W BELL RD STE 100A
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City | GLENDALE
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State | AZ
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Zip | 85308-3780
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Country | US
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Telephone | 480-999-5114
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Fax | 480-459-3339
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | MARY WAWERU
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Credential | CNP
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Telephone | 480-999-5114
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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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