Provider Demographics
NPI:1629554126
Name:ARIZONA INTERGRATED TELE PSYCHIATRY AND TELE MEDICINE SERVICES LLC
Entity Type:Organization
Organization Name:ARIZONA INTERGRATED TELE PSYCHIATRY AND TELE MEDICINE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MEDINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMAU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-867-1722
Mailing Address - Street 1:2735 E MAIN ST STE 2&3
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-9269
Mailing Address - Country:US
Mailing Address - Phone:480-867-1722
Mailing Address - Fax:480-867-1709
Practice Address - Street 1:2735 E MAIN ST STE 2&3
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-9269
Practice Address - Country:US
Practice Address - Phone:480-867-1722
Practice Address - Fax:480-867-1709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7446103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty