Organization
DESERT BOLT BEHAVIORAL LLC
Active
Other names
Desert Bolt Behavioral LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VALERY A NKENDONG APRN (CEO)
(480) 527-0042
Entity
Organization
Contact information
Practice address
42201 N 41ST DR STE 160, ANTHEM, AZ 85086-3803
(850) 527-0042
(480) 296-0002
Mailing address
42201 N 41ST DR STE 160, ANTHEM, AZ 85086-3803
(850) 527-0042
(480) 296-0002
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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120200727001036
—
AZ
Enumeration date
06/28/2020
Last updated
07/05/2021
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