Organization
DESERT CLOVER PSYCHIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN KODYSZ (CHIEF OPERATIONS OFFICER)
(602) 492-2121
Entity
Organization
Contact information
Practice address
2601 N 3RD ST STE 205, PHOENIX, AZ 85004-1145
(602) 492-2121
Mailing address
2601 N 3RD ST STE 205, PHOENIX, AZ 85004-1145
(602) 492-2121
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/28/2022
Last updated
10/04/2023
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