Provider Demographics
NPI:1265162895
Name:SIMPLE PSYCHIATRY AND MENTAL HEALTH
Entity type:Organization
Organization Name:SIMPLE PSYCHIATRY AND MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEANOR EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMILAO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:602-531-1059
Mailing Address - Street 1:7553 N SUMMIT PASS
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-4598
Mailing Address - Country:US
Mailing Address - Phone:602-531-1059
Mailing Address - Fax:
Practice Address - Street 1:7553 N SUMMIT PASS
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86315-4598
Practice Address - Country:US
Practice Address - Phone:602-531-1059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty