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Organization
MYALO MENTAL HEALTH, PLLC
Active
Organization
MYALO MENTAL HEALTH, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON BROWN PMHNP-BC (PMHNP, OWNER)
(602) 647-8249
Entity
Organization
Contact information
Practice address
21639 N 12TH AVE STE 104, PHOENIX, AZ 85027-2802
(602) 647-8249
Mailing address
21639 N 12TH AVE STE 104, PHOENIX, AZ 85027-2802
(602) 647-8249
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
822748
—
AZ
01
—
AP4920
CERTIFIED NURSE PRACTITIONER LICENSE
AZ
Enumeration date
07/31/2024
Last updated
09/23/2024
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