Individual
JUSTIN RANDAL MICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
2500 E VAN BUREN ST, PHOENIX, AZ 85008-6037
(602) 220-6078
(602) 220-6293
Mailing address
3420 E CLARENDON AVE, PHOENIX, AZ 85018-5758
(480) 532-7765
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
TAP4472
AZ
Other
Enumeration date
04/30/2012
Last updated
04/30/2012
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