Provider Demographics
NPI:1124735006
Name:GHAZI, ABBAS (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ABBAS
Middle Name:
Last Name:GHAZI
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4742 N 24TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-9107
Mailing Address - Country:US
Mailing Address - Phone:480-848-1935
Mailing Address - Fax:
Practice Address - Street 1:4742 N 24TH ST STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-9107
Practice Address - Country:US
Practice Address - Phone:480-848-1935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ283298363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health