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General NPI Number Information
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NPI Number | 1790607208
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Entity Type | Organization
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Legal Business Name | MIRA PSYCHIATRY GROUP PLLC
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Dates
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Enumeration Date | 07/27/2026
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Last Update Date | 07/27/2026
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Provider Practice Location Address
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Address Line | 405 W SOUTHERN AVE STE 105
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City | TEMPE
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State | AZ
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Zip | 85282-4500
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Country | US
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Telephone | 480-900-0965
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Fax |
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Provider Business Mailing Address
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Address Line | 22424 S ELLSWORTH LOOP RD UNIT 784
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-7107
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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 | THOMAS MATHEW
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Credential | FNP-C, PMHNP-C
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Telephone | 480-900-0965
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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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