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General NPI Number Information
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NPI Number | 1710732466
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Entity Type | Organization
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Legal Business Name | MINDWELL LLC
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Dates
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Enumeration Date | 04/17/2024
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 2460 W PECOS AVE
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City | TEMPE
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State | AZ
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Zip | 85202
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Country | US
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Telephone | 480-580-1353
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 W ELLIOT RD
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City | TEMPE
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State | AZ
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Zip | 85284-1107
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Country | US
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Telephone | 480-580-1353
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHELLE GILREATH
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Credential | PMHNP-BC
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Telephone | 480-580-1353
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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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