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General NPI Number Information
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NPI Number | 1740380724
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Entity Type | Organization
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Legal Business Name | PATHHEALER, LTD
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1037 E MISSOURI AVE
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City | PHOENIX
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State | AZ
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Zip | 85014-2663
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Country | US
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Telephone | 602-393-2373
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Fax | 602-393-2374
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Provider Business Mailing Address
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Address Line | 5025 N CENTRAL AVE PMB 607
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City | PHOENIX
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State | AZ
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Zip | 85012-1520
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Country | US
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Telephone | 602-393-2373
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Fax | 602-393-2374
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Authorized Official
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Title or Position | OWNER
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Name | MARY M DESCH
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Credential | MD
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Telephone | 602-393-2373
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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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