Organization
IDEAL SELF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA CHILDS FNP, PMHNP (OWNER/PROVIDER)
(623) 303-6777
Entity
Organization
Contact information
Practice address
12620 N CAVE CREEK RD STE 10A, PHOENIX, AZ 85022-6528
(623) 303-6777
Mailing address
12620 N CAVE CREEK RD STE 10A, PHOENIX, AZ 85022-6528
(623) 303-6777
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/10/2022
Last updated
03/19/2023
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