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NPI Code Detail

MEDICARE: PHOENIX MENTAL HEALTH AND WELLNESS PLLC

MEDICARE: PHOENIX MENTAL HEALTH AND 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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAP11496AZ

General Provider Information

NPI Number : 1396227609
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHOENIX MENTAL HEALTH AND WELLNESS PLLC
Provider Business Mailing Address
First Line : 5551 S WHITE MOUNTAIN RD UNIT 2
Second Line :
City : SHOW LOW
State : AZ
Zip : 85901-7449
Country : US
Telephone Number : 928-985-1495
Fax Number : 928-597-5198
Provider Business Practice Location Address
First Line : 914 N SAN FRANCISCO ST STE D
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86001-3254
Country : US
Telephone Number : 928-985-1495
Fax Number : 985-597-5198
Authorized Official
Title or Position : PMHNP
Name : LYNN COOPER JOHNSON
Credential :
Telephone Number : 928-985-1495
Provider Enumeration Date : 09/04/2018
Last Update Date : 03/04/2020

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Directions to “PHOENIX MENTAL HEALTH AND WELLNESS PLLC ” Practice Location

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