Provider Demographics
NPI:1619747342
Name:NEW VISION BEHAVIORAL HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:NEW VISION BEHAVIORAL HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:610-772-3325
Mailing Address - Street 1:4409 N 179TH DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-5201
Mailing Address - Country:US
Mailing Address - Phone:480-287-1932
Mailing Address - Fax:
Practice Address - Street 1:3119 N 46TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-3705
Practice Address - Country:US
Practice Address - Phone:480-287-1932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory