Provider Demographics
NPI:1568177483
Name:EMERGENT MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:EMERGENT MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARDULA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-20609
Authorized Official - Phone:623-278-4610
Mailing Address - Street 1:17404 N JAVELINA DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2955
Mailing Address - Country:US
Mailing Address - Phone:623-278-4610
Mailing Address - Fax:
Practice Address - Street 1:17404 N JAVELINA DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2955
Practice Address - Country:US
Practice Address - Phone:623-278-4610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health