| Tailored Psychiatric Wellness Center | |
|
6751 N Sunset Blvd Ste 320 Glendale AZ 85305-3155 | |
| (708) 829-1520 | |
| Not Available |
| Full Name | Tailored Psychiatric Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 6751 N Sunset Blvd Ste 320, Glendale, Arizona |
| Authorized Official Name and Position | Tonia Wallace (AUTHORIZED OFFICIAL/OWNER) |
| Authorized Official Contact | 7088291520 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tailored Psychiatric Wellness Center 2956 Chattering Ln Southaven MS 38672-6108 Ph: () - | Tailored Psychiatric Wellness Center 6751 N Sunset Blvd Ste 320 Glendale AZ 85305-3155 Ph: (708) 829-1520 |
| NPI Number | 1023872454 |
|---|---|
| Provider Enumeration Date | 02/07/2024 |
| Last Update Date | 02/29/2024 |
| Medicare PECOS PAC ID | 4981041373 |
|---|---|
| Medicare Enrollment ID | O20240320004061 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023872454 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Tonia Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700531498 PECOS PAC ID: 7911381496 Enrollment ID: I20221004000859 |
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