| Lifewell - Mitchell | |
|
40 E Mitchell Dr Phoenix AZ 85012-2330 | |
| (602) 808-2800 | |
| (602) 808-2750 |
| Full Name | Lifewell - Mitchell |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 40 E Mitchell Dr, Phoenix, Arizona |
| Authorized Official Name and Position | Doris Vaught (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6025995420 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifewell - Mitchell 202 E Earll Drive Suite 200 Phoenix AZ 85012-2647 Ph: (602) 808-2800 | Lifewell - Mitchell 40 E Mitchell Dr Phoenix AZ 85012-2330 Ph: (602) 808-2800 |
| NPI Number | 1104111061 |
|---|---|
| Provider Enumeration Date | 06/17/2011 |
| Last Update Date | 11/23/2020 |
| Certification Date | 11/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104111061 | NPI | - | NPPES |
| 617175 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | OTC6539 (Arizona) | Primary |
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