| Phoenix Mind Body Connection Llc | |
|
2942 N. 24th St Suite 114 Phoenix AZ 85016 | |
| (602) 235-0575 | |
| (602) 241-9580 |
| Full Name | Phoenix Mind Body Connection Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2942 N. 24th St Suite 114, Phoenix, Arizona |
| Authorized Official Name and Position | Shirley D Hanson (CEO) |
| Authorized Official Contact | 6024713124 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Mind Body Connection Llc Po Box 16998 Phoenix AZ 85011-6998 Ph: () - | Phoenix Mind Body Connection Llc 2942 N. 24th St Suite 114 Phoenix AZ 85016 Ph: (602) 235-0575 |
| NPI Number | 1588366959 |
|---|---|
| Provider Enumeration Date | 03/20/2023 |
| Last Update Date | 03/20/2023 |
| Certification Date | 03/17/2023 |
| Medicare PECOS PAC ID | 0345615183 |
|---|---|
| Medicare Enrollment ID | O20230410002363 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588366959 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Shirley D Hanson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891930228 PECOS PAC ID: 9638437213 Enrollment ID: I20180103003157 |
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