Provider Demographics
NPI:1619570728
Name:RICHLIN HIGHTOWER BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:RICHLIN HIGHTOWER BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:UMOREN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:480-262-4797
Mailing Address - Street 1:135 E RAY RD STE 5-6
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-3376
Mailing Address - Country:US
Mailing Address - Phone:480-262-4797
Mailing Address - Fax:
Practice Address - Street 1:135 E RAY RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-3376
Practice Address - Country:US
Practice Address - Phone:623-444-5989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ391538Medicaid