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4121 E Valley Auto Dr Mesa AZ 85206-4631 | |
| (704) 506-6267 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 4121 E Valley Auto Dr, Mesa, Arizona |
| Authorized Official Name and Position | Leslie Johnson (CEO) |
| Authorized Official Contact | 7045066267 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
11000 Optum Cir Eden Prairie MN 55344-2503 Ph: (704) 506-6267 | 4121 E Valley Auto Dr Mesa AZ 85206-4631 Ph: (704) 506-6267 |
| NPI Number | 1942070370 |
|---|---|
| Provider Enumeration Date | 01/05/2024 |
| Last Update Date | 04/24/2024 |
| Certification Date | 04/24/2024 |
| Medicare PECOS PAC ID | 0941648463 |
|---|---|
| Medicare Enrollment ID | O20240717001855 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942070370 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Eva R Besmanoff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598062275 PECOS PAC ID: 5597981589 Enrollment ID: I20140728002678 |
| Provider Name | Mary Elizabeth (beth) Piraino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134605868 PECOS PAC ID: 8820405426 Enrollment ID: I20210326001503 |
| Provider Name | Krystine Garcia |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982357919 PECOS PAC ID: 6709311319 Enrollment ID: I20241119004225 |
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