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General NPI Number Information
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NPI Number | 1760050546
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Entity Type | Organization
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Legal Business Name | PINE CREEK MENTAL HEALTH CLINIC
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 9635 W SAGELINE ROAD
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City | PAYSON
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State | AZ
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Zip | 85541
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Country | US
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Telephone | 480-735-8334
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Fax |
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Provider Business Mailing Address
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Address Line | 9635 W SAGELINE ROAD
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City | PAYSON
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State | AZ
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Zip | 85541
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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 | OWNER
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Name | ALICIA SEXTON
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Credential | NP
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Telephone | 807-358-3344
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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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