Organization
OLIVE BRANCH BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY MUTHONI NDUNGU NP (PMHNP-BC)
(508) 615-7980
Entity
Organization
Contact information
Practice address
1644 W MCNEIL ST, PHOENIX, AZ 85041-3762
(508) 615-7980
Mailing address
1347 E BRIARWOOD TER, PHOENIX, AZ 85048-8691
(508) 615-7980
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BH7714
—
AZ
Enumeration date
08/18/2022
Last updated
08/18/2022
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