# WANDERIST BEHAVIORAL HEALTH PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295559441
- **Authorized official:** NICOLE CARLSON LCSW, PMHNP-BC (PSYCHIATRIC NURSE PRACTITIONER)
- **Authorized official phone:** (626) 515-8875

## Contact information

- **Practice address:** 2600 E SOUTHERN AVE STE C3, TEMPE, AZ 85282-7609
- **Practice address phone:** (626) 515-8875
- **Mailing address:** 2600 E SOUTHERN AVE STE C3, TEMPE, AZ 85282-7609
- **Mailing address phone:** (626) 515-8875

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/14/2024
- **Last updated:** 11/14/2024