Provider Demographics
NPI:1811287097
Name:LATEEF MENTAL WELLNESS INC
Entity type:Organization
Organization Name:LATEEF MENTAL WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:LATEEF
Authorized Official - Suffix:
Authorized Official - Credentials:MHNP
Authorized Official - Phone:602-403-5050
Mailing Address - Street 1:PO BOX 26249
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068-6249
Mailing Address - Country:US
Mailing Address - Phone:602-403-5050
Mailing Address - Fax:623-847-4047
Practice Address - Street 1:7219 S 15TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6930
Practice Address - Country:US
Practice Address - Phone:602-406-5050
Practice Address - Fax:623-847-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-09
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1782103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP99718Medicare UPIN