Individual
JERLEEL HARTWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11630 W BLOOMFIELD RD, EL MIRAGE, AZ 85335-3915
(602) 622-9594
Mailing address
1520 S 216TH LN, BUCKEYE, AZ 85326-8030
(602) 620-4377
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1234567
—
AZ
Enumeration date
05/01/2022
Last updated
05/01/2022
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