# SOUTH MOUNTAIN FAMILY PSYCHIATRY, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1336788868
- **Authorized official:** MR. JOHN W WILSON JR. (BUSINESS MANAGER)
- **Authorized official phone:** (602) 418-9105

## Contact information

- **Practice address:** 11022 S 51ST ST STE 250, PHOENIX, AZ 85044-4308
- **Practice address phone:** (480) 939-6137
- **Practice address fax:** (602) 429-8445
- **Mailing address:** 11022 S 51ST ST STE 250, PHOENIX, AZ 85044-4308
- **Mailing address phone:** (480) 939-6137
- **Mailing address fax:** (602) 429-8445

## 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:** 01/01/2020
- **Last updated:** 06/21/2021