Provider Demographics
NPI:1669953287
Name:MICHAEL FORBES WARDEN PHD PLLC
Entity type:Organization
Organization Name:MICHAEL FORBES WARDEN PHD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FORBES
Authorized Official - Last Name:WARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-525-2109
Mailing Address - Street 1:1233 N MESA DR APT 1117
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-2758
Mailing Address - Country:US
Mailing Address - Phone:602-525-2109
Mailing Address - Fax:
Practice Address - Street 1:7155 W CAMPO BELLO DR STE C120
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8594
Practice Address - Country:US
Practice Address - Phone:623-322-7301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1021261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)