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NPI Code Detail

MEDICARE: PATHHEALER, LTD

MEDICARE: PATHHEALER, LTD
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
12084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1740380724
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATHHEALER, LTD
Provider Business Mailing Address
First Line : 5025 N CENTRAL AVE
Second Line : PMB 607
City : PHOENIX
State : AZ
Zip : 85012-1520
Country : US
Telephone Number : 602-393-2373
Fax Number : 602-393-2374
Provider Business Practice Location Address
First Line : 1037 E MISSOURI AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-2663
Country : US
Telephone Number : 602-393-2373
Fax Number : 602-393-2374
Authorized Official
Title or Position : OWNER
Name : MARY M DESCH
Credential : MD
Telephone Number : 602-393-2373
Provider Enumeration Date : 09/22/2006
Last Update Date : 08/22/2020

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