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Organization
BETHEL HILLS INTEGRATED HEALTHCARE PLLC
Active
Organization
BETHEL HILLS INTEGRATED HEALTHCARE PLLC
Active
Other names
Bethel Hills Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
OLUBUKOLA KOMOLAFE DNP, PMHNP-BC, FNP-B (MEDICAL DIRECTOR)
(832) 542-3181
Entity
Organization
Contact information
Practice address
13838 S 46TH PL STE 340, PHOENIX, AZ 85044-7805
(832) 542-3181
Mailing address
13838 S 46TH PL STE 340, PHOENIX, AZ 85044-7805
(832) 542-3181
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
NULL
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
084714
—
AZ
05
—
606122
—
AZ
Enumeration date
03/04/2021
Last updated
02/14/2022
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