| East Valley Psychiatry Llc | |
|
1301 S Crismon Rd Mesa AZ 85209-3767 | |
| (623) 308-2472 | |
| Not Available |
| Full Name | East Valley Psychiatry Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1301 S Crismon Rd, Mesa, Arizona |
| Authorized Official Name and Position | Daniel Merrill (OWNER) |
| Authorized Official Contact | 6233082472 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Valley Psychiatry Llc 2036 N Gilbert Rd # 2-134 Mesa AZ 85203-2139 Ph: (623) 308-2472 | East Valley Psychiatry Llc 1301 S Crismon Rd Mesa AZ 85209-3767 Ph: (623) 308-2472 |
| NPI Number | 1992240857 |
|---|---|
| Provider Enumeration Date | 01/03/2017 |
| Last Update Date | 01/03/2017 |
| Medicare PECOS PAC ID | 1355626565 |
|---|---|
| Medicare Enrollment ID | O20170329002371 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992240857 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Daniel K Merrill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609895671 PECOS PAC ID: 1658398482 Enrollment ID: I20051031000664 |
| Provider Name | Nancy E Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245255637 PECOS PAC ID: 8628081932 Enrollment ID: I20060802000412 |
| Provider Name | David A Fife |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659569697 PECOS PAC ID: 4789771312 Enrollment ID: I20071030000203 |
| Provider Name | Aaron R Wilson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982871463 PECOS PAC ID: 0941479497 Enrollment ID: I20110817000901 |
| Provider Name | Sara J Edmund |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730441825 PECOS PAC ID: 0749427656 Enrollment ID: I20130515000092 |
| Provider Name | Cathy L Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770929135 PECOS PAC ID: 6305089459 Enrollment ID: I20130821000641 |
| Provider Name | Mark A Goforth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699198747 PECOS PAC ID: 3870724933 Enrollment ID: I20140402002577 |
| Provider Name | Stephanie L Teubner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043764467 PECOS PAC ID: 0143518787 Enrollment ID: I20161013001418 |
| Provider Name | Laura A Barket |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659614469 PECOS PAC ID: 7113216557 Enrollment ID: I20170503001314 |
| Provider Name | Ian G Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427576859 PECOS PAC ID: 9234491127 Enrollment ID: I20180312001486 |
| Provider Name | Regan V O'brien |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578950978 PECOS PAC ID: 6406198613 Enrollment ID: I20190508000925 |
| Provider Name | Khalid Salim Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821452418 PECOS PAC ID: 1153696653 Enrollment ID: I20190820001834 |
| Provider Name | Shaun D Daidone |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710244975 PECOS PAC ID: 3779873823 Enrollment ID: I20191214000492 |
| Provider Name | Devin L Wengert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346709557 PECOS PAC ID: 4284064197 Enrollment ID: I20200416002507 |
| Provider Name | Preston Strebeck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619584406 PECOS PAC ID: 8820400484 Enrollment ID: I20201224000039 |
| Provider Name | Tallan T Depriest |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548794399 PECOS PAC ID: 0547531105 Enrollment ID: I20211021002747 |
| Provider Name | Melanie Hope Oglesby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871268359 PECOS PAC ID: 9830587591 Enrollment ID: I20211028002637 |
| Provider Name | Erica Castillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326632563 PECOS PAC ID: 4789919689 Enrollment ID: I20220321001830 |
| Provider Name | Kolter Lee Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063130227 PECOS PAC ID: 1951778117 Enrollment ID: I20221101003057 |
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