Organization
INDIGO CREST WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESTER SHAW (OWNER)
(602) 341-6977
Entity
Organization
Contact information
Practice address
2960 E NORTHERN AVE, PHOENIX, AZ 85028-4845
(602) 341-6977
Mailing address
2960 E NORTHERN AVE, PHOENIX, AZ 85028-4845
(602) 341-6977
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
04/11/2023
Last updated
04/11/2023
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