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General NPI Number Information
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NPI Number | 1992285852
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Entity Type | Organization
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Legal Business Name | ACT MENTAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 30 ACOMA BLVD S
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5957
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Country | US
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Telephone | 855-647-4228
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Fax |
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Provider Business Mailing Address
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Address Line | 2924 PONY DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-8432
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Country | US
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Telephone | 507-380-7218
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JUNE ANN STALEY
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Credential | PMHNP-BC
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Telephone | 855-647-4228
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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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