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General NPI Number Information
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NPI Number | 1891043311
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Entity Type | Organization
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Legal Business Name | EAST VALLEY MENTAL WELLNESS PLLC
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 1166 E WARNER RD SUITE 101
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City | GILBERT
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State | AZ
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Zip | 85296-3064
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Country | US
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Telephone | 480-570-0497
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Fax | 480-452-0145
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Provider Business Mailing Address
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Address Line | 1166 E WARNER RD SUITE 101
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City | GILBERT
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State | AZ
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Zip | 85296-3064
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Country | US
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Telephone | 480-570-0497
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Fax | 480-452-0145
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Authorized Official
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Title or Position | MEMBER
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Name | ANN MARIE CASEY
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Credential | PMHNP
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Telephone | 480-570-0497
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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 | AP4476
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License Number State | AZ
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