Basic Information
| Provider Information | |||||||||
| NPI: | 1164166377 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELITE MENTAL HEALTH AND WELLNESS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6738 S TUCANA LN | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852988784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146291828 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6738 S TUCANA LN | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852988784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146291828 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2022 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | WAWERU | ||||||||
| AuthorizedOfficialFirstName: | STELLA | ||||||||
| AuthorizedOfficialMiddleName: | WAMUYU | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3146291828 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.