| Mind 247 Practice Llc | |
|
2728 N 24th St Phoenix AZ 85008-1050 | |
| (844) 646-3247 | |
| Not Available |
| Full Name | Mind 247 Practice Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2728 N 24th St, Phoenix, Arizona |
| Authorized Official Name and Position | Aisha Lynn Depriest (DIRECTOR OF CREDENTIALING) |
| Authorized Official Contact | 4803694008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind 247 Practice Llc 1465 N Scottsdale Rd Ste 400 Scottsdale AZ 85257-3634 Ph: (844) 646-3247 | Mind 247 Practice Llc 2728 N 24th St Phoenix AZ 85008-1050 Ph: (844) 646-3247 |
| NPI Number | 1902472467 |
|---|---|
| Provider Enumeration Date | 06/03/2021 |
| Last Update Date | 10/04/2022 |
| Certification Date | 10/04/2022 |
| Medicare PECOS PAC ID | 6406253541 |
|---|---|
| Medicare Enrollment ID | O20210916001566 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902472467 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Vernon Barksdale |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871547380 PECOS PAC ID: 5698768935 Enrollment ID: I20040405000539 |
| Provider Name | John J Lee |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1568534741 PECOS PAC ID: 9335153881 Enrollment ID: I20060203000413 |
| Provider Name | Annette D Bunn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831265354 PECOS PAC ID: 4183694433 Enrollment ID: I20110310000615 |
| Provider Name | Tarry Wolfe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982655338 PECOS PAC ID: 1052459559 Enrollment ID: I20110606000748 |
| Provider Name | Kristen Lyn Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447545645 PECOS PAC ID: 8527237569 Enrollment ID: I20110809000606 |
| Provider Name | Joycelyn Connet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225377898 PECOS PAC ID: 3870732712 Enrollment ID: I20130625000533 |
| Provider Name | Roy Lee Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578583209 PECOS PAC ID: 8426108481 Enrollment ID: I20140428000003 |
| Provider Name | Adiza J Sulley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427369420 PECOS PAC ID: 6305096215 Enrollment ID: I20140721002280 |
| Provider Name | Chyllia D Dixon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174916472 PECOS PAC ID: 7719298033 Enrollment ID: I20150612000863 |
| Provider Name | Bose Anifowose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932589322 PECOS PAC ID: 7719294081 Enrollment ID: I20150918000867 |
| Provider Name | Kimberly Keene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285004234 PECOS PAC ID: 2668781154 Enrollment ID: I20151023000975 |
| Provider Name | Susan K Jostes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356776819 PECOS PAC ID: 5799084109 Enrollment ID: I20160505001053 |
| Provider Name | Latanya M Willis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225235005 PECOS PAC ID: 8123331071 Enrollment ID: I20160909000431 |
| Provider Name | Nadia Ledesma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477006989 PECOS PAC ID: 9335421999 Enrollment ID: I20170117001139 |
| Provider Name | Mirandine A Alce |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841678943 PECOS PAC ID: 3870806821 Enrollment ID: I20170308001654 |
| Provider Name | Hamda H Awaal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710373923 PECOS PAC ID: 2567769037 Enrollment ID: I20170323000888 |
| Provider Name | Amy Priftakis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508212960 PECOS PAC ID: 4385915008 Enrollment ID: I20170728002897 |
| Provider Name | Tanya L Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184116824 PECOS PAC ID: 3779830906 Enrollment ID: I20180719001363 |
| Provider Name | Laura Masters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154793685 PECOS PAC ID: 5092025874 Enrollment ID: I20180801003465 |
| Provider Name | Margarita Madrid |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619476207 PECOS PAC ID: 6901150028 Enrollment ID: I20181108000733 |
| Provider Name | Mark Gregory Sonenschein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457816597 PECOS PAC ID: 5991046542 Enrollment ID: I20190408001778 |
| Provider Name | Phillis C Mutembete |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215230081 PECOS PAC ID: 3476895269 Enrollment ID: I20190426000476 |
| Provider Name | Patience R Akhimien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346617594 PECOS PAC ID: 8729397773 Enrollment ID: I20190604000948 |
| Provider Name | Amy Renee Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457905812 PECOS PAC ID: 2264764182 Enrollment ID: I20191025002561 |
| Provider Name | Albert Pierce |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841850377 PECOS PAC ID: 0547692584 Enrollment ID: I20191113002826 |
| Provider Name | Kevin Demarcus Lowrey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407499635 PECOS PAC ID: 1658706536 Enrollment ID: I20200123000474 |
| Provider Name | Anthony Kimani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295370401 PECOS PAC ID: 2365877842 Enrollment ID: I20200123001343 |
| Provider Name | Shannon Janine Crawford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275164337 PECOS PAC ID: 3173951456 Enrollment ID: I20200319002854 |
| Provider Name | Francis Kangere Kahiga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477185759 PECOS PAC ID: 2567891773 Enrollment ID: I20200408003598 |
| Provider Name | Jacob Johns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235779737 PECOS PAC ID: 1456772193 Enrollment ID: I20200604000461 |
| Provider Name | Ketura C James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548508237 PECOS PAC ID: 4284860529 Enrollment ID: I20200706000167 |
| Provider Name | Vincent P Ekstrom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124644794 PECOS PAC ID: 2062838238 Enrollment ID: I20200818003624 |
| Provider Name | Toni R Crawford-jonas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467069567 PECOS PAC ID: 2062832132 Enrollment ID: I20201012002777 |
| Provider Name | Terri Collins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831702513 PECOS PAC ID: 9436569316 Enrollment ID: I20201104000837 |
| Provider Name | Shereen Breuer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619577186 PECOS PAC ID: 0042620825 Enrollment ID: I20201105002666 |
| Provider Name | Flora Issanda Stowater |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700274321 PECOS PAC ID: 2961813571 Enrollment ID: I20201202001632 |
| Provider Name | Yolanda Baugh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215536479 PECOS PAC ID: 5890108542 Enrollment ID: I20210119002261 |
| Provider Name | Gwendolyn Mathis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194183137 PECOS PAC ID: 0143529677 Enrollment ID: I20210129001123 |
| Provider Name | Amanda Kate Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295376945 PECOS PAC ID: 0941626527 Enrollment ID: I20210224001327 |
| Provider Name | Paulette D Winsor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568054195 PECOS PAC ID: 7012324817 Enrollment ID: I20210323001094 |
| Provider Name | Kenneth Afueh Nembu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841810371 PECOS PAC ID: 9335556430 Enrollment ID: I20210407000442 |
| Provider Name | Jennifer Steele |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487249710 PECOS PAC ID: 7416365531 Enrollment ID: I20210409000225 |
| Provider Name | Kelly L Heffron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043895030 PECOS PAC ID: 7416365077 Enrollment ID: I20210420001124 |
| Provider Name | Meshack Samia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760014047 PECOS PAC ID: 4183055239 Enrollment ID: I20210429002800 |
| Provider Name | Ihuoma U Nwoke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629666789 PECOS PAC ID: 6406255322 Enrollment ID: I20210623003005 |
| Provider Name | Jerica Elaine M Lim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043884026 PECOS PAC ID: 7618379447 Enrollment ID: I20210715001933 |
| Provider Name | Nikka Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962939454 PECOS PAC ID: 4082040928 Enrollment ID: I20210819003588 |
| Provider Name | Rachel L Bardos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265003081 PECOS PAC ID: 4385049360 Enrollment ID: I20210830001975 |
| Provider Name | James Fiske |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013525534 PECOS PAC ID: 5294131520 Enrollment ID: I20210910002214 |
| Provider Name | Delphine Valentin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982205944 PECOS PAC ID: 7618375841 Enrollment ID: I20211001001733 |
| Provider Name | Mary M Ndungu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487326914 PECOS PAC ID: 1254729908 Enrollment ID: I20211028002350 |
| Provider Name | Dorothy C Igwe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073038824 PECOS PAC ID: 9739577107 Enrollment ID: I20211104001097 |
| Provider Name | Shawn J Dugan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841825155 PECOS PAC ID: 7618391483 Enrollment ID: I20211111000623 |
| Provider Name | Limy Fernandus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972005189 PECOS PAC ID: 8820424070 Enrollment ID: I20211216002411 |
| Provider Name | Lakshmi Nair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720588742 PECOS PAC ID: 2769731819 Enrollment ID: I20220202002667 |
| Provider Name | Caroline Waceke Miya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992266712 PECOS PAC ID: 7012301278 Enrollment ID: I20220303002147 |
| Provider Name | Stephanie J Dockins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114559366 PECOS PAC ID: 5597150318 Enrollment ID: I20220315000277 |
| Provider Name | Jose Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669086641 PECOS PAC ID: 4183043383 Enrollment ID: I20220606002043 |
| Provider Name | Mojisola R Balogun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144567264 PECOS PAC ID: 7012255904 Enrollment ID: I20220606002368 |
| Provider Name | Marquita Lagarde |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902247570 PECOS PAC ID: 0749662567 Enrollment ID: I20220726002926 |
| Provider Name | Charles Bear Bradley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982347852 PECOS PAC ID: 6507248176 Enrollment ID: I20220728001677 |
| Provider Name | Tamara Perryman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255688339 PECOS PAC ID: 5496773244 Enrollment ID: I20220926003300 |
| Provider Name | Ian Pedregosa Dy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780288852 PECOS PAC ID: 6901212653 Enrollment ID: I20221004000767 |
| Provider Name | Vanessa Arvizu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225773468 PECOS PAC ID: 2567848898 Enrollment ID: I20221010002317 |
| Provider Name | Lafayette Bishop |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588387989 PECOS PAC ID: 4587033063 Enrollment ID: I20221205001814 |
| Provider Name | Julie Ann Bainbridge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073237210 PECOS PAC ID: 3274902234 Enrollment ID: I20221213003311 |
| Provider Name | Michael S Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588339923 PECOS PAC ID: 7012391816 Enrollment ID: I20221219001197 |
| Provider Name | Jennifer Lynn Ruth Beaupre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437823143 PECOS PAC ID: 1759787112 Enrollment ID: I20230125001328 |
| Provider Name | James N Maigua |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912614611 PECOS PAC ID: 8921479080 Enrollment ID: I20230127001013 |
| Provider Name | Preston Jay Frank |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720704851 PECOS PAC ID: 1759753619 Enrollment ID: I20230202002480 |
| Provider Name | Abbas Ghazi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124735006 PECOS PAC ID: 9133591837 Enrollment ID: I20230206002661 |
| Provider Name | Anna Lavette Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801594890 PECOS PAC ID: 5395100556 Enrollment ID: I20230424001611 |
| Provider Name | Debra K Gibson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811694482 PECOS PAC ID: 4486019478 Enrollment ID: I20230426001900 |
| Provider Name | Tyler Weber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457056582 PECOS PAC ID: 3072978964 Enrollment ID: I20230427003008 |
| Provider Name | Jamie Wade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225730997 PECOS PAC ID: 9234596305 Enrollment ID: I20230605002198 |
| Provider Name | Marcus Ernest Konyi Kometa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003522954 PECOS PAC ID: 4688036692 Enrollment ID: I20230808002078 |
| Provider Name | Ashleigh Michelle Mcdonnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023789963 PECOS PAC ID: 8224492434 Enrollment ID: I20230906003147 |
| Provider Name | Felicia D Thomas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134801053 PECOS PAC ID: 2961855283 Enrollment ID: I20240201004273 |
| Provider Name | Andrea Hinton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942067533 PECOS PAC ID: 7719420439 Enrollment ID: I20240621001683 |
| Provider Name | Myra Nikira Castillo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235817156 PECOS PAC ID: 0345787438 Enrollment ID: I20240807001915 |
| Provider Name | Mary Katherine Garcia |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932541372 PECOS PAC ID: 1759814072 Enrollment ID: I20241024004315 |
| Provider Name | Carley Mccarthy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437827284 PECOS PAC ID: 3678947736 Enrollment ID: I20241031003241 |
| Provider Name | Elizabeth Marie Giroux |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477301398 PECOS PAC ID: 3375076995 Enrollment ID: I20241104001682 |
| Provider Name | Melinda K Callicoat |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811252554 PECOS PAC ID: 6507390002 Enrollment ID: I20241106001987 |
| Provider Name | Emily R Ratliff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831957190 PECOS PAC ID: 6709311269 Enrollment ID: I20241121001465 |
| Provider Name | Troy D. E. Curtis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689457327 PECOS PAC ID: 5496271249 Enrollment ID: I20250428001123 |
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