Provider Demographics
NPI:1922522242
Name:TREE OF LIFE MENTAL HEALTH SYSTEMS, LLC
Entity Type:Organization
Organization Name:TREE OF LIFE MENTAL HEALTH SYSTEMS, LLC
Other - Org Name:TREE OF LIFE MENTAL HEALTH SYSTEMS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENTON
Authorized Official - Middle Name:KENDYLE
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-981-1153
Mailing Address - Street 1:8400 W VIRGINIA AVE APT 1138
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-8370
Mailing Address - Country:US
Mailing Address - Phone:702-981-1153
Mailing Address - Fax:702-974-4555
Practice Address - Street 1:8400 W. VIRGINIA
Practice Address - Street 2:#1138
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037
Practice Address - Country:US
Practice Address - Phone:702-981-1153
Practice Address - Fax:702-974-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1609350608Medicaid
NV1069350608Medicaid