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General NPI Number Information
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NPI Number | 1376122184
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Entity Type | Organization
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Legal Business Name | ESTRELLA MENTAL HEALTH SERVICES, PLLC
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 12725 W INDIAN SCHOOL RD STE E101
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City | AVONDALE
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State | AZ
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Zip | 85392-9525
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Country | US
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Telephone | 623-640-7682
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Fax | 855-932-1312
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Provider Business Mailing Address
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Address Line | 12725 W INDIAN SCHOOL RD STE E101
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City | AVONDALE
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State | AZ
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Zip | 85392-9525
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Country | US
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Telephone | 623-640-7682
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Fax | 855-932-1312
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. DARYL IAN COTTON
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Credential | PMHNP-BC
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Telephone | 623-640-7682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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