Provider Demographics
NPI: | 1821639642 |
---|---|
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: | AZITTS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CLINICAL DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MEDINA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KAMAU |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
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 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: | 2019-10-02 |
Last Update Date: | 2024-04-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | Group - Multi-Specialty | |
No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Multi-Specialty | |
No | 164W00000X | Nursing Service Providers | Licensed Practical Nurse | Group - Multi-Specialty | |
No | 251B00000X | Agencies | Case Management | ||
No | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | Group - Multi-Specialty |
No | 347C00000X | Transportation Services | Private Vehicle | Group - Multi-Specialty | |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |