Provider Demographics
NPI:1417642091
Name:HEALTHY MINDS BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:HEALTHY MINDS BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESHAWN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-557-0050
Mailing Address - Street 1:1114 W MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-1748
Mailing Address - Country:US
Mailing Address - Phone:602-334-1041
Mailing Address - Fax:602-825-1325
Practice Address - Street 1:1114 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-1748
Practice Address - Country:US
Practice Address - Phone:602-334-1041
Practice Address - Fax:602-825-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC12763OtherAZDHS