Organization
TJ GARDNER CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAYDEN WON MIN PHILLIP DUFF (OWNER)
(480) 466-4837
Entity
Organization
Contact information
Practice address
1722 N BANNING STE 101B, MESA, AZ 85205-3350
(480) 466-4837
Mailing address
1722 N BANNING STE 101B, MESA, AZ 85205-3350
(480) 466-4837
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
01/30/2023
Last updated
03/01/2024
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