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General NPI Number Information
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NPI Number | 1477249134
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Entity Type | Organization
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Legal Business Name | HER SEASON BEHAVIORAL WELLNESS AND PSYCHIATRY LLC
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 2210 S MILL AVE STE 7A
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City | TEMPE
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State | AZ
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Zip | 85282-2153
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Country | US
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Telephone | 928-587-1147
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Fax |
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Provider Business Mailing Address
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Address Line | 2077 E WILLIS RD
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City | GILBERT
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State | AZ
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Zip | 85297-2087
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALLYSEN KELLY
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Credential | NP
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Telephone | 928-587-1147
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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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