MEDICARE: DESERT CLOVER PSYCHIATRY, LLC

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

General Provider Information

NPI Number	:	1316693419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT CLOVER PSYCHIATRY, LLC

Provider Business Mailing Address
First Line	:	2601 N 3RD ST STE 205
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1145
Country	:	US
Telephone Number	:	602-492-2121
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 N 3RD ST STE 205
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1145
Country	:	US
Telephone Number	:	602-492-2121
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	JUSTIN KODYSZ
Credential	:
Telephone Number	:	602-492-2121

Provider Enumeration Date	:	02/28/2022
Last Update Date	:	10/04/2023

Similar Medicare Providers

1386649796 — DR. ISMAR CINTORA M.D.
Practice Location Address:

2601 N 3RD ST , STE 203
PHOENIX, AZ
85004-1145

Practice Phone: 602-279-4442
Practice Fax: 602-279-5333

1245698265 — DR. JESUS ANTONIO LOVETT II PSYD
Practice Location Address:

2601 N 3RD ST STE 217
PHOENIX, AZ
85004-1145

Practice Phone: 480-999-1353
Practice Fax:

1528675469 — ANTELOPE WORKS, LLC
Practice Location Address:

2601 N 3RD ST STE 200
PHOENIX, AZ
85004-1145

Practice Phone: 602-456-6896
Practice Fax:

1215697941 — LOGAN KODYSZ NP
Practice Location Address:

2601 N 3RD ST STE 205
PHOENIX, AZ
85004-1145

Practice Phone: 602-492-2121
Practice Fax: 602-354-9301

1568248110 — MEGHAN TERWILLIGER
Practice Location Address:

2601 N 3RD ST STE 205
PHOENIX, AZ
85004-1145

Practice Phone: 602-492-2121
Practice Fax:

1063266658 — LACY GARTH PMHNP-BC
Practice Location Address:

2601 N 3RD ST STE 205
PHOENIX, AZ
85004-1145

Practice Phone: 480-494-3164
Practice Fax: 602-354-9301

Directions to “DESERT CLOVER PSYCHIATRY, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.