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NPI Code Detail

MEDICARE: LIFEWELL BEHAVIORAL WELLNESS

MEDICARE: LIFEWELL BEHAVIORAL WELLNESS
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
1251S00000XCommunity/Behavioral Health AgencyOTC5920AZ

Other Identifiers

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

General Provider Information

NPI Number : 1386939247
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFEWELL BEHAVIORAL WELLNESS
Provider Business Mailing Address
First Line : 202 E EARLL DRIVE
Second Line : SUITE 200
City : PHOENIX
State : AZ
Zip : 85012-2647
Country : US
Telephone Number : 602-808-2800
Fax Number : 602-808-2755
Provider Business Practice Location Address
First Line : 262 E. UNIVERSITY DRIVE
Second Line :
City : MESA
State : AZ
Zip : 85201-5932
Country : US
Telephone Number : 602-808-2800
Fax Number : 602-808-2750
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : DORIS VAUGHT
Credential :
Telephone Number : 602-599-5420
Provider Enumeration Date : 06/17/2011
Last Update Date : 11/23/2020

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Directions to “LIFEWELL BEHAVIORAL WELLNESS ” 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.

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