| Wisteria Mental Health & Wellness Center PLLC | |
|
301 W Echo Ln Phoenix AZ 85021-5554 | |
| (480) 399-8455 | |
| (866) 845-1832 |
| Full Name | Wisteria Mental Health & Wellness Center PLLC |
|---|---|
| Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
| Location | 301 W Echo Ln, Phoenix, Arizona |
| Authorized Official Name and Position | Roberto Igor Bracamonte Valencia (CEO) |
| Authorized Official Contact | 6023503046 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wisteria Mental Health & Wellness Center PLLC 14802 N 18th Pl Phoenix AZ 85022-3925 Ph: (480) 399-8455 | Wisteria Mental Health & Wellness Center PLLC 301 W Echo Ln Phoenix AZ 85021-5554 Ph: (480) 399-8455 |
| NPI Number | 1194413419 |
|---|---|
| Provider Enumeration Date | 04/25/2023 |
| Last Update Date | 03/14/2025 |
| Certification Date | 03/14/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194413419 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | () | Primary |
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