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3458 E Southern Ave Ste 103 Mesa AZ 85204-5681 | |
| (480) 569-3377 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 3458 E Southern Ave Ste 103, Mesa, Arizona |
| Authorized Official Name and Position | Olukemi Akinbusuyi (ADMINISTRATOR) |
| Authorized Official Contact | 4805693377 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3458 E Southern Ave Ste 103 Mesa AZ 85204-5681 Ph: (480) 569-3377 | 3458 E Southern Ave Ste 103 Mesa AZ 85204-5681 Ph: (480) 569-3377 |
| NPI Number | 1457051948 |
|---|---|
| Provider Enumeration Date | 03/03/2023 |
| Last Update Date | 10/26/2023 |
| Certification Date | 10/26/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457051948 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 163WP0807X | Registered Nurse - Psychiatric/mental Health, Child & Adolescent | (* (Not Available)) | Secondary |
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