Organization
NUPHASE HEALTH SERVICES, LLC
Active
Other names
NuPhase Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. QIANA MICHELE MAYBERRY (CHIEF ADMINISTRATIVE OFFICER)
(717) 747-6522
Entity
Organization
Contact information
Practice address
4225 W GLENDALE AVE STE A102, PHOENIX, AZ 85051-8195
(717) 747-6522
Mailing address
14613 E DESERT VISTA TRL, SCOTTSDALE, AZ 85262-7826
(717) 747-6522
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164883
—
AZ
01
—
CSLG11865
AZ COUNSELING FACILITY LICENSE
AZ
Enumeration date
02/03/2022
Last updated
07/24/2023
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