# DESERT CLOVER PSYCHIATRY, LLC

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

## Provider details

- **NPI number:** 1316693419
- **Authorized official:** JUSTIN KODYSZ (CHIEF OPERATIONS OFFICER)
- **Authorized official phone:** (602) 492-2121

## Contact information

- **Practice address:** 2601 N 3RD ST STE 205, PHOENIX, AZ 85004-1145
- **Practice address phone:** (602) 492-2121
- **Mailing address:** 2601 N 3RD ST STE 205, PHOENIX, AZ 85004-1145
- **Mailing address phone:** (602) 492-2121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/28/2022
- **Last updated:** 10/04/2023