Organization
BACK TO LIFE MENTAL HEALTH LLC
Active
Other names
Back to Life Mental Health PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
LOGAN ELI CARTON PMHNP (MANAGER/OWNER)
(480) 353-7133
Entity
Organization
Contact information
Practice address
20860 N TATUM BLVD, PHOENIX, AZ 85050-4274
(503) 833-3778
Mailing address
20860 N TATUM BLVD, PHOENIX, AZ 85050-4274
(503) 833-3778
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/21/2023
Last updated
11/17/2023
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