Organization
MAKINI MENTAL HEALTH CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY KIDIAVAYI NP (PROVIDER)
(602) 856-6116
Entity
Organization
Contact information
Practice address
8805 N 23RD AVE STE 100, PHOENIX, AZ 85021-4172
(602) 856-6116
(602) 856-6122
Mailing address
8805 N 23RD AVE STE 100, PHOENIX, AZ 85021-4172
(602) 856-6116
(602) 856-6122
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
01/26/2023
Last updated
09/11/2024
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