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NPI Code Detail

MEDICARE: GRACEWELL BEHAVIORAL HEALTH PLLC

MEDICARE: GRACEWELL BEHAVIORAL HEALTH 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 Practitioner
2363L00000XNurse Practitioner

General Provider Information

NPI Number : 1467399972
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRACEWELL BEHAVIORAL HEALTH PLLC
Provider Business Mailing Address
First Line : 1717 W NORTHERN AVE STE 107
Second Line :
City : PHOENIX
State : AZ
Zip : 85021-5400
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1717 W NORTHERN AVE STE 107
Second Line :
City : PHOENIX
State : AZ
Zip : 85021-5400
Country : US
Telephone Number : 781-985-1314
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : GRACE NASSANGA
Credential :
Telephone Number : 781-985-1314
Provider Enumeration Date : 05/01/2026
Last Update Date : 05/01/2026

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Directions to “GRACEWELL BEHAVIORAL HEALTH PLLC ” Practice Location

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