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General NPI Number Information
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NPI Number | 1609563204
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Entity Type | Organization
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Legal Business Name | ADDISON BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 1717 S DORSEY LN APT 3070
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City | TEMPE
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State | AZ
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Zip | 85281-7007
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Country | US
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Telephone | 817-734-6325
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Fax |
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Provider Business Mailing Address
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Address Line | 914 E BROADWAY RD # 1113
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City | TEMPE
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State | AZ
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Zip | 85282-1502
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Country | US
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Telephone | 817-734-6325
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | MR. DUNCAN MAINA MWANGI
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Credential |
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Telephone | 817-734-6325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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