Provider Demographics
NPI:1861240202
Name:HEADLIGHT MENTAL HEALTHCARE PLLC
Entity type:Organization
Organization Name:HEADLIGHT MENTAL HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-618-7023
Mailing Address - Street 1:2 N CENTRAL AVE STE 1800
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2139
Mailing Address - Country:US
Mailing Address - Phone:480-618-7023
Mailing Address - Fax:480-781-4866
Practice Address - Street 1:2 N CENTRAL AVE STE 1800
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2139
Practice Address - Country:US
Practice Address - Phone:480-618-7023
Practice Address - Fax:480-781-4866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty