Provider Demographics
NPI:1801394184
Name:SERENITY PSYCHIATRIC HEALTH INC.
Entity Type:Organization
Organization Name:SERENITY PSYCHIATRIC HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INGE
Authorized Official - Middle Name:GISELA
Authorized Official - Last Name:BUNDCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:623-698-2567
Mailing Address - Street 1:143 N MCCORMICK ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2725
Mailing Address - Country:US
Mailing Address - Phone:928-899-7784
Mailing Address - Fax:
Practice Address - Street 1:143 N MCCORMICK ST STE 103
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2725
Practice Address - Country:US
Practice Address - Phone:928-899-7784
Practice Address - Fax:623-218-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4183363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1942532734OtherNPI