Organization
LIFEWELL BEHAVIORAL WELLNESS
Active
Organization
LIFEWELL BEHAVIORAL WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORIS VAUGHT (ECECUTIVE VICE PRESIDENT/CFO)
(602) 599-5420
Entity
Organization
Contact information
Practice address
3540 E BASELINE RD, SUITE 150, PHOENIX, AZ 85042-9630
(602) 808-2800
(602) 808-2799
Mailing address
202 E EARLL DR, SUITE 200, PHOENIX, AZ 85012-2634
(602) 808-2800
(602) 808-2799
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
OTC7810
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037445
—
AZ
Enumeration date
07/28/2015
Last updated
11/04/2016
Update your record
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