| Emergent Mental Health Services Llc | |
|
17404 N Javelina Dr Surprise AZ 85374-2955 | |
| (623) 278-4610 | |
| Not Available |
| Full Name | Emergent Mental Health Services Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 17404 N Javelina Dr, Surprise, Arizona |
| Authorized Official Name and Position | Carrie Mardula (OWNER) |
| Authorized Official Contact | 6232784610 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Emergent Mental Health Services Llc 17404 N Javelina Dr Surprise AZ 85374-2955 Ph: (623) 278-4610 | Emergent Mental Health Services Llc 17404 N Javelina Dr Surprise AZ 85374-2955 Ph: (623) 278-4610 |
| NPI Number | 1568177483 |
|---|---|
| Provider Enumeration Date | 01/16/2023 |
| Last Update Date | 01/26/2024 |
| Certification Date | 01/26/2024 |
| Medicare PECOS PAC ID | 2769835768 |
|---|---|
| Medicare Enrollment ID | O20240228002170 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568177483 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Carrie Mardula |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164177739 PECOS PAC ID: 6204271364 Enrollment ID: I20240228002423 |
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