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Organization

AHP PSYCH NP PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KELLY BLACK PMHNP (OWNER/PMHNP)
(951) 623-7194
Entity
Organization

Contact information

Practice address
1910 S STAPLEY DR STE 120, MESA, AZ 85204-6676
(602) 341-3303
Mailing address
1910 S STAPLEY DR STE 120, MESA, AZ 85204-6676
(602) 341-3303

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary

Other

Enumeration date
11/13/2024
Last updated
03/04/2025
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