| Light At The End Behavioral Health Services | |
|
21168 E Ocotillo Rd # 1045 Queen Creek AZ 85142-8175 | |
| (623) 265-6220 | |
| (866) 491-7389 |
| Full Name | Light At The End Behavioral Health Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 21168 E Ocotillo Rd # 1045, Queen Creek, Arizona |
| Authorized Official Name and Position | Shavaun J Johnson (CEO) |
| Authorized Official Contact | 4808252152 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Light At The End Behavioral Health Services 21168 E Ocotillo Rd # 1045 Queen Creek AZ 85142-8175 Ph: (623) 265-6220 | Light At The End Behavioral Health Services 21168 E Ocotillo Rd # 1045 Queen Creek AZ 85142-8175 Ph: (623) 265-6220 |
| NPI Number | 1114690401 |
|---|---|
| Provider Enumeration Date | 08/01/2021 |
| Last Update Date | 08/13/2024 |
| Certification Date | 08/06/2024 |
| Medicare PECOS PAC ID | 0244675403 |
|---|---|
| Medicare Enrollment ID | O20240227002695 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114690401 | NPI | - | NPPES |
| Provider Name | Shavaun J Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225624729 PECOS PAC ID: 7113320177 Enrollment ID: I20210728001658 |
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