Provider Demographics
NPI:1841811908
Name:SACRED HEARTS PSYCHIATRY & ADDICTION MEDICINE
Entity type:Organization
Organization Name:SACRED HEARTS PSYCHIATRY & ADDICTION MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER/NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC PMHNP
Authorized Official - Phone:480-392-1729
Mailing Address - Street 1:7047 E GREENWAY PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-8113
Mailing Address - Country:US
Mailing Address - Phone:480-392-1729
Mailing Address - Fax:
Practice Address - Street 1:7047 E GREENWAY PKWY STE 250
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-8113
Practice Address - Country:US
Practice Address - Phone:480-392-1729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRED HEARTS PSYCHIATRY & ADDICTION MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center