Provider Demographics
NPI:1972229375
Name:ADVANCED PSYCHIATRIC HEALTH PLLC
Entity Type:Organization
Organization Name:ADVANCED PSYCHIATRIC HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGWA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:480-930-2322
Mailing Address - Street 1:4435 E CHANDLER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4435 E CHANDLER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7651
Practice Address - Country:US
Practice Address - Phone:480-930-2322
Practice Address - Fax:480-546-4964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ080377Medicaid