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Organization
SOUTH MOUNTAIN FAMILY PSYCHIATRY, LLC
Active
Organization
SOUTH MOUNTAIN FAMILY PSYCHIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN W WILSON JR. (BUSINESS MANAGER)
(602) 418-9105
Entity
Organization
Contact information
Practice address
11022 S 51ST ST STE 250, PHOENIX, AZ 85044-4308
(480) 939-6137
(602) 429-8445
Mailing address
11022 S 51ST ST STE 250, PHOENIX, AZ 85044-4308
(480) 939-6137
(602) 429-8445
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/01/2020
Last updated
06/21/2021
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