Organization
ARIZONA WELLCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RHONDA RUSSELL (OWNER)
(866) 661-3816
Entity
Organization
Contact information
Practice address
2515 E THOMAS RD STE 16, PHOENIX, AZ 85016-7946
(866) 661-3816
Mailing address
2515 E THOMAS RD STE 16, PHOENIX, AZ 85016-7946
(866) 661-3816
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
Other
Enumeration date
11/22/2019
Last updated
11/22/2019
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