Organization
LIFEWELL BEHAVIORAL WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORIS VAUGHT (PRESIDENT/CEO)
(602) 599-5420
Entity
Organization
Contact information
Practice address
40 E MITCHELL DR STE 100&200, PHOENIX, AZ 85012-2330
(602) 808-2800
Mailing address
202 E EARLL DR, SUITE 200, PHOENIX, AZ 85012-2634
(602) 808-2800
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
OTC7723
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
494978
—
AZ
Enumeration date
07/28/2015
Last updated
07/17/2024
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