Provider Demographics
NPI:1043061187
Name:OWN YOUR PATH WELLNESS
Entity Type:Organization
Organization Name:OWN YOUR PATH WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PARIS
Authorized Official - Middle Name:CHRISTA
Authorized Official - Last Name:MANDY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:623-256-2136
Mailing Address - Street 1:12350 W CAMELBACK RD UNIT 70
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-5634
Mailing Address - Country:US
Mailing Address - Phone:623-256-2136
Mailing Address - Fax:
Practice Address - Street 1:1650 N DYSART RD STE 3
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1116
Practice Address - Country:US
Practice Address - Phone:623-256-2136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty