Provider Demographics
NPI:1922693480
Name:MUTHONI, MERCY WENDY
Entity Type:Individual
Prefix:
First Name:MERCY
Middle Name:WENDY
Last Name:MUTHONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8509 S 41ST DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7823
Mailing Address - Country:US
Mailing Address - Phone:858-344-4746
Mailing Address - Fax:480-546-4743
Practice Address - Street 1:4602 W DONNER DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-4264
Practice Address - Country:US
Practice Address - Phone:858-344-4746
Practice Address - Fax:520-455-3200
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness