MEDICARE: JUST 1 LIFE SERVICES 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

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

General Provider Information

NPI Number	:	1609334812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUST 1 LIFE SERVICES LLC

Provider Business Mailing Address
First Line	:	1616 E MAIN ST STE 223
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-9074
Country	:	US
Telephone Number	:	480-477-9199
Fax Number	:	480-477-9199

Provider Business Practice Location Address
First Line	:	1616 E MAIN ST STE 223
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-9074
Country	:	US
Telephone Number	:	480-477-9199
Fax Number	:	480-477-9199

Authorized Official
Title or Position	:	CFO
Name	:	ERICA HOWARD
Credential	:
Telephone Number	:	480-477-9199

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	03/06/2026

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Directions to “JUST 1 LIFE SERVICES LLC ” Practice Location

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