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General NPI Number Information
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NPI Number | 1760152037
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Entity Type | Individual
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Provider Name | DESTINY PYLE
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Gender | Female
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Dates
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Enumeration Date | 09/17/2021
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | 8128 E HWY 69 111
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314
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Country | US
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Telephone | 928-679-2191
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 N CARLA VISTA DR
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-7306
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Country | US
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Telephone | 602-579-5477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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