WHITE MOUNTAIN WELLNESS CLINIC LLC NPI 1073038758

NPI Information

NPI: 1073038758
Provider Name: WHITE MOUNTAIN WELLNESS CLINIC LLC

Former Legal Business Name: WHITE MOUNTAIN WELLNESS CLINIC

Classification: Nurse Practitioner - 363LP0808X
Entity Type: Organization

Specialization: Psychiatric/Mental Health

Address:
151 N WHITE MOUNTAIN RD STE E
SHOW LOW, AZ
ZIP 85901
Phone: (480) 886-4466
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WHITE MOUNTAIN WELLNESS CLINIC LLC is a psychiatric/mental health nurse practitioner in Show Low, AZ. WHITE MOUNTAIN WELLNESS CLINIC LLC NPI is 1073038758. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is White Mountain Wellness Clinic.

The provider's business location address is:

151 N WHITE MOUNTAIN RD STE E
SHOW LOW, AZ
ZIP 85901-298
Phone: (480) 886-4466
Fax: (928) 563-1006

The provider's authorized official is Holly Engelman .
The authorized official title is Nurse Practitioner and has the following contact phone number (928) 233-6551.

The enumeration date for this NPI number is 8/3/2017 and was last updated on 3/27/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care		ARIZONA	No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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