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NPI Code Detail

MEDICARE: SOUTHWEST MIND INSTITUTE PLLC

MEDICARE: SOUTHWEST MIND INSTITUTE 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1730014689
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHWEST MIND INSTITUTE PLLC
Provider Business Mailing Address
First Line : 743 W MCLELLAN BLVD
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-1032
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 W CLARENDON AVE STE 140
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-3449
Country : US
Telephone Number : 623-396-6822
Fax Number :
Authorized Official
Title or Position : OWNER/DIRECTOR
Name : NICOLE WEANT
Credential : LCSW
Telephone Number : 917-900-6623
Provider Enumeration Date : 06/15/2026
Last Update Date : 06/15/2026

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Directions to “SOUTHWEST MIND INSTITUTE PLLC ” Practice Location

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