Provider Demographics
NPI:1144747940
Name:AXIS MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:AXIS MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DARRYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKELVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-948-6086
Mailing Address - Street 1:1230 W SANTA ANA BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-3835
Mailing Address - Country:US
Mailing Address - Phone:714-582-2714
Mailing Address - Fax:
Practice Address - Street 1:1230 W SANTA ANA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3835
Practice Address - Country:US
Practice Address - Phone:949-501-5979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AXIS MENTAL HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-23
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health