Provider Demographics
NPI:1568133510
Name:SERENE PSYCHIATRY LLC.
Entity Type:Organization
Organization Name:SERENE PSYCHIATRY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:623-688-1508
Mailing Address - Street 1:34406 N. 27TH DR.
Mailing Address - Street 2:OFFICE 103 SUITE 140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6079
Mailing Address - Country:US
Mailing Address - Phone:623-688-1508
Mailing Address - Fax:602-698-9668
Practice Address - Street 1:34406 N. 27TH DR.
Practice Address - Street 2:OFFICE 103 SUITE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6079
Practice Address - Country:US
Practice Address - Phone:623-688-1508
Practice Address - Fax:602-698-9668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMM5904998OtherPMHNP-BC