| Estrella Mental Health Services, Pllc | |
|
12725 W Indian School Rd Ste E101 Avondale AZ 85392-9525 | |
| (623) 640-7682 | |
| (855) 932-1312 |
| Full Name | Estrella Mental Health Services, Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 12725 W Indian School Rd Ste E101, Avondale, Arizona |
| Authorized Official Name and Position | Daryl Ian Cotton (OWNER/CEO) |
| Authorized Official Contact | 6236407682 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Estrella Mental Health Services, Pllc 12725 W Indian School Rd Ste E101 Avondale AZ 85392-9525 Ph: (623) 640-7682 | Estrella Mental Health Services, Pllc 12725 W Indian School Rd Ste E101 Avondale AZ 85392-9525 Ph: (623) 640-7682 |
| NPI Number | 1376122184 |
|---|---|
| Provider Enumeration Date | 04/07/2021 |
| Last Update Date | 06/10/2022 |
| Certification Date | 06/10/2022 |
| Medicare PECOS PAC ID | 6901298694 |
|---|---|
| Medicare Enrollment ID | O20220107001853 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376122184 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Daryl I Cotton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972852846 PECOS PAC ID: 4880930577 Enrollment ID: I20190117001127 |
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