# IDEAL SELF LLC

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

## Provider details

- **NPI number:** 1467182774
- **Authorized official:** ANGELA CHILDS FNP, PMHNP (OWNER/PROVIDER)
- **Authorized official phone:** (623) 303-6777

## Contact information

- **Practice address:** 12620 N CAVE CREEK RD STE 10A, PHOENIX, AZ 85022-6528
- **Practice address phone:** (623) 303-6777
- **Mailing address:** 12620 N CAVE CREEK RD STE 10A, PHOENIX, AZ 85022-6528
- **Mailing address phone:** (623) 303-6777

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 06/10/2022
- **Last updated:** 03/19/2023