# BACK TO LIFE MENTAL HEALTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Back to Life Mental Health PLLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932988763
- **Authorized official:** LOGAN ELI CARTON PMHNP (MANAGER/OWNER)
- **Authorized official phone:** (480) 353-7133

## Contact information

- **Practice address:** 20860 N TATUM BLVD, PHOENIX, AZ 85050-4274
- **Practice address phone:** (503) 833-3778
- **Mailing address:** 20860 N TATUM BLVD, PHOENIX, AZ 85050-4274
- **Mailing address phone:** (503) 833-3778

## 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:** 09/21/2023
- **Last updated:** 11/17/2023