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Organization

WANDERIST BEHAVIORAL HEALTH PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
NICOLE CARLSON LCSW, PMHNP-BC (PSYCHIATRIC NURSE PRACTITIONER)
(626) 515-8875
Entity
Organization

Contact information

Practice address
2600 E SOUTHERN AVE STE C3, TEMPE, AZ 85282-7609
(626) 515-8875
Mailing address
2600 E SOUTHERN AVE STE C3, TEMPE, AZ 85282-7609
(626) 515-8875

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary

Other

Enumeration date
11/14/2024
Last updated
11/14/2024
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