Provider Demographics
NPI:1881240760
Name:POOL OF BETHESDA PSYCHIATRIC HEALTH LLC
Entity type:Organization
Organization Name:POOL OF BETHESDA PSYCHIATRIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, ARNP PMHNP-BC
Authorized Official - Phone:520-333-4949
Mailing Address - Street 1:18747 N REEMS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8645
Mailing Address - Country:US
Mailing Address - Phone:877-396-5133
Mailing Address - Fax:520-526-9962
Practice Address - Street 1:18747 N REEMS RD STE 500
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8645
Practice Address - Country:US
Practice Address - Phone:877-396-5133
Practice Address - Fax:520-526-9962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty