Organization
OPTIMUS BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FLORA ISSANDA STOWATER PSYCH NP (OWNER/PROVIDER)
(480) 840-4777
Entity
Organization
Contact information
Practice address
4600 E WASHINGTON ST STE 300, PHOENIX, AZ 85034-1908
(480) 840-4777
Mailing address
PO BOX 697, LAVEEN, AZ 85339-0697
(480) 840-4777
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700274321
—
AZ
Enumeration date
10/05/2023
Last updated
10/05/2023
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