Organization
MENTAL HEALTH AZFORVETS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VARONICA FREEMAN (BILLING MANAGER)
(513) 260-9643
Entity
Organization
Contact information
Practice address
20469 N 95TH DR, PEORIA, AZ 85382-5133
(248) 821-8587
(855) 300-5330
Mailing address
20469 N 95TH DR, PEORIA, AZ 85382-5133
(248) 821-8587
(855) 300-5330
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161359
—
AZ
Enumeration date
10/30/2019
Last updated
10/30/2019
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