Provider Demographics
NPI:1184307670
Name:FOUR SEASONS MENTAL HEALTH PLLC
Entity type:Organization
Organization Name:FOUR SEASONS MENTAL HEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSTENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-707-4625
Mailing Address - Street 1:8405 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-8009
Mailing Address - Country:US
Mailing Address - Phone:928-814-2569
Mailing Address - Fax:
Practice Address - Street 1:711 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-707-4625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)