Provider Demographics
NPI:1710663430
Name:180 MENTAL HEALTH AND WELLNESS, LLC.
Entity Type:Organization
Organization Name:180 MENTAL HEALTH AND WELLNESS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:STUFF
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, PMHNP
Authorized Official - Phone:480-721-7055
Mailing Address - Street 1:9855 E SOUTHERN AVE # 50729
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3801
Mailing Address - Country:US
Mailing Address - Phone:480-721-7055
Mailing Address - Fax:
Practice Address - Street 1:3404 W CHERYL DR STE A150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9615
Practice Address - Country:US
Practice Address - Phone:480-863-5250
Practice Address - Fax:480-896-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty