Provider Demographics
NPI:1710539614
Name:NEWU BEHAVIORAL HEALTH & WELLNESS CLINIC, PLLC
Entity type:Organization
Organization Name:NEWU BEHAVIORAL HEALTH & WELLNESS CLINIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MA/ OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-584-8923
Mailing Address - Street 1:13540 W CAMINO DEL SOL STE 3
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4435
Mailing Address - Country:US
Mailing Address - Phone:623-584-8923
Mailing Address - Fax:844-628-1655
Practice Address - Street 1:13540 W CAMINO DEL SOL STE 3
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4435
Practice Address - Country:US
Practice Address - Phone:623-584-8923
Practice Address - Fax:844-628-1655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWU BEHAVIORAL HEALTH & WELLNESS CLINIC, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-10
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ201246Medicaid
AZ160368Medicaid
AZZ193283Medicaid
AZ139936Medicaid