Provider Demographics
NPI:1982782199
Name:ARIZONA MENTAL HEALTH INSTITUTE LLC
Entity Type:Organization
Organization Name:ARIZONA MENTAL HEALTH INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:602-824-3717
Mailing Address - Street 1:10019 N 41ST DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1016
Mailing Address - Country:US
Mailing Address - Phone:602-824-3717
Mailing Address - Fax:
Practice Address - Street 1:10019 N 41ST DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1016
Practice Address - Country:US
Practice Address - Phone:602-824-3717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN113748363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDEAOtherMT0682927