MEDICARE: PHOENIX MENTAL HEALTH & WELLNESS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043900335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX MENTAL HEALTH & WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	11865 W TULANE DR
Second Line	:
City	:	MORRISON
State	:	CO
Zip	:	80465-1179
Country	:	US
Telephone Number	:	303-868-5436
Fax Number	:

Provider Business Practice Location Address
First Line	:	5353 W DARTMOUTH AVE STE 400
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80227-5517
Country	:	US
Telephone Number	:	303-868-5436
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PROVIDER
Name	:	CAMIE L VASQUEZ
Credential	:	PMHNP-BC
Telephone Number	:	303-868-5436

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	06/06/2023

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