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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 AgencyOTC7810AZ

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 : 1609251057
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFEWELL BEHAVIORAL WELLNESS
Provider Business Mailing Address
First Line : 202 E EARLL DR
Second Line : SUITE 200
City : PHOENIX
State : AZ
Zip : 85012-2634
Country : US
Telephone Number : 602-808-2800
Fax Number : 602-808-2799
Provider Business Practice Location Address
First Line : 3540 E BASELINE RD
Second Line : SUITE 150
City : PHOENIX
State : AZ
Zip : 85042-9630
Country : US
Telephone Number : 602-808-2800
Fax Number : 602-808-2799
Authorized Official
Title or Position : ECECUTIVE VICE PRESIDENT/CFO
Name : DORIS VAUGHT
Credential :
Telephone Number : 602-599-5420
Provider Enumeration Date : 07/28/2015
Last Update Date : 11/04/2016

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Directions to “LIFEWELL BEHAVIORAL WELLNESS ” Practice Location

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