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Organization
BACK TO LIFE MENTAL HEALTH LLC
Active
Organization
BACK TO LIFE MENTAL HEALTH LLC
Active
Other names
Back to Life Mental Health PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
LOGAN ELI CARTON PMHNP (MANAGER/OWNER)
(480) 353-7133
Entity
Organization
Contact information
Practice address
20860 N TATUM BLVD, PHOENIX, AZ 85050-4274
(503) 833-3778
Mailing address
20860 N TATUM BLVD, PHOENIX, AZ 85050-4274
(503) 833-3778
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
09/21/2023
Last updated
11/17/2023
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