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General NPI Number Information
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NPI Number | 1689153769
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Entity Type | Organization
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Legal Business Name | DENOVA COLLABORATIVE HEALTH, LLC
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 235 W WESTERN AVE
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City | AVONDALE
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State | AZ
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Zip | 85323-1848
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Country | US
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Telephone | 602-230-7373
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Fax | 623-230-3086
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Provider Business Mailing Address
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Address Line | 3101 N CENTRAL AVE STE 550
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City | PHOENIX
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State | AZ
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Zip | 85012-2635
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Country | US
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Telephone | 602-230-7373
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GRAHAM JOHNSON
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Credential |
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Telephone | 602-230-7373
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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 | OTC9070
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | OTC9070
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | OTC9070
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | OTC9070
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License Number State | AZ
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | OTC9070
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License Number State | AZ
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