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General NPI Number Information
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NPI Number | 1740931625
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Entity Type | Organization
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Legal Business Name | SPIRIT-MIND-BODY HEALTHCARE PLLC
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 9950 W VAN BUREN ST STE 115
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City | AVONDALE
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State | AZ
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Zip | 85323-5318
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Country | US
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Telephone | 623-218-6691
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Fax |
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Provider Business Mailing Address
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Address Line | 8017 W ALBENIZ PL
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City | PHOENIX
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State | AZ
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Zip | 85043-1698
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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 | CEO
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Name | EZINNE IROKU
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Credential | NP
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Telephone | 623-218-6691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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