Organization
LIFEWELL BEHAVIORAL WELLNESS
Active
Organization
LIFEWELL BEHAVIORAL WELLNESS
Active
Other names
Lifewell - Mitchell
Organization subpart
No
Provider details
NPI number
Authorized official
DORIS VAUGHT (CHIEF EXECUTIVE OFFICER)
(602) 599-5420
Entity
Organization
Contact information
Practice address
40 E MITCHELL DR, PHOENIX, AZ 85012-2330
(602) 808-2800
(602) 808-2750
Mailing address
202 E EARLL DRIVE, SUITE 200, PHOENIX, AZ 85012-2647
(602) 808-2800
(602) 808-2755
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
OTC6539
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
617175
—
AZ
Enumeration date
06/17/2011
Last updated
11/23/2020
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