Provider Demographics
NPI:1750901088
Name:FOOTHILLS PSYCHIATRIC SERVICES PLLC
Entity type:Organization
Organization Name:FOOTHILLS PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-209-7731
Mailing Address - Street 1:3546 E WINDMERE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7211
Mailing Address - Country:US
Mailing Address - Phone:316-209-7731
Mailing Address - Fax:
Practice Address - Street 1:1921 S ALMA SCHOOL RD STE 312
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3039
Practice Address - Country:US
Practice Address - Phone:480-608-4877
Practice Address - Fax:480-608-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty