| Brook Of Cherith Psych Consult Llc | |
|
4111 E Valley Auto Dr Ste 201 Mesa AZ 85206-4609 | |
| (602) 842-3600 | |
| Not Available |
| Full Name | Brook Of Cherith Psych Consult Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4111 E Valley Auto Dr Ste 201, Mesa, Arizona |
| Authorized Official Name and Position | Bamidele Odede (CEO) |
| Authorized Official Contact | 4475278326 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brook Of Cherith Psych Consult Llc 21412 S 230th St Queen Creek AZ 85142-0823 Ph: (443) 527-8326 | Brook Of Cherith Psych Consult Llc 4111 E Valley Auto Dr Ste 201 Mesa AZ 85206-4609 Ph: (602) 842-3600 |
| NPI Number | 1295432250 |
|---|---|
| Provider Enumeration Date | 02/10/2023 |
| Last Update Date | 07/08/2023 |
| Certification Date | 07/08/2023 |
| Medicare PECOS PAC ID | 6406202902 |
|---|---|
| Medicare Enrollment ID | O20231019000914 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295432250 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Bamidele Odede |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831693357 PECOS PAC ID: 4789939752 Enrollment ID: I20220913000908 |
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