Provider Demographics
NPI:1770317422
Name:DESERT CANYON PSYCHIATRY
Entity type:Organization
Organization Name:DESERT CANYON PSYCHIATRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VENESSA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP, PMHNP
Authorized Official - Phone:602-349-9546
Mailing Address - Street 1:5560 W GERONIMO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4448
Mailing Address - Country:US
Mailing Address - Phone:602-349-9546
Mailing Address - Fax:480-864-9440
Practice Address - Street 1:11011 S 48TH ST STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1787
Practice Address - Country:US
Practice Address - Phone:602-730-9670
Practice Address - Fax:480-864-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty