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General NPI Number Information
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NPI Number | 1942173646
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Entity Type | Organization
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Legal Business Name | AZT GROUP LLC
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 18456 N 25TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85023-1213
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Country | US
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Telephone | 480-219-7098
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Fax |
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Provider Business Mailing Address
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Address Line | 6635 W HAPPY VALLEY RD STE A104
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City | GLENDALE
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State | AZ
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Zip | 85310-2609
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Country | US
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Telephone | 480-219-7098
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BRIAN CARLISLE
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Credential | FNP-C
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Telephone | 480-219-7098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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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 | 364SP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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