Provider Demographics
NPI:1770226151
Name:MINDFUL MENTAL HEALTH AZ SUN LLC
Entity Type:Organization
Organization Name:MINDFUL MENTAL HEALTH AZ SUN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STANSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-314-7225
Mailing Address - Street 1:40304 W LOCOCO ST
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-5137
Mailing Address - Country:US
Mailing Address - Phone:602-314-7225
Mailing Address - Fax:602-314-7226
Practice Address - Street 1:40304 W LOCOCO ST
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-5137
Practice Address - Country:US
Practice Address - Phone:602-314-7225
Practice Address - Fax:602-314-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty