Provider Demographics
NPI:1821798828
Name:INTENTIONAL PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:INTENTIONAL PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ARVIZU
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:520-619-1696
Mailing Address - Street 1:7287 E HEARTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-6138
Mailing Address - Country:US
Mailing Address - Phone:520-619-1696
Mailing Address - Fax:
Practice Address - Street 1:7287 E HEARTWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85756
Practice Address - Country:US
Practice Address - Phone:520-619-1696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health