Provider Demographics
NPI:1710539614
Name:NEWU BEHAVIORAL HEALTH & WELLNESS CLINIC, PLLC
Entity Type:Organization
Organization Name:NEWU BEHAVIORAL HEALTH & WELLNESS CLINIC, PLLC
Other - Org Name:NEWU WEIGHTLOSS & WELLNESS CLINIC, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MA/ OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINOS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:602-697-6963
Mailing Address - Street 1:15411 W WADDELL RD
Mailing Address - Street 2:STE 102, PMB 1169
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8431
Mailing Address - Country:US
Mailing Address - Phone:602-697-6963
Mailing Address - Fax:844-628-1655
Practice Address - Street 1:13354 WEST JOCOBSON DRIVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-5397
Practice Address - Country:US
Practice Address - Phone:602-697-6963
Practice Address - Fax:844-628-1655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWU BEHAVIORAL HEALTH & WELLNESS CLINIC, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-10
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ193283Medicaid
AZZ201246Medicaid
AZ139936Medicaid
AZ160368Medicaid