Organization
DENOVA COLLABORATIVE HEALTH, LLC
Active
Other names
Denova Collaborative Health
Organization subpart
No
Provider details
NPI number
Authorized official
GRAHAM JOHNSON (CEO)
(602) 230-7373
Entity
Organization
Contact information
Practice address
2204 S DOBSON RD STE 102, MESA, AZ 85202-6457
(602) 230-7373
Mailing address
3101 N CENTRAL AVE STE 500, PHOENIX, AZ 85012-2639
(602) 230-7373
(602) 682-7455
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
AZ
207Q00000X
Family Medicine Physician
Primary
—
AZ
2084P0800X
Psychiatry Physician
—
AZ
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AZ
Enumeration date
06/30/2017
Last updated
06/05/2024
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