Basic Information
| Provider Information | |||||||||
| NPI: | 1336720325 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASANTE TELEPSYCHIATRIC AND MOBILE SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10845 E DRAGOON AVE | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852087609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174495235 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10845 E DRAGOON AVE | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852087609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174495235 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2021 | ||||||||
| LastUpdateDate: | 04/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | OWUSU-ANSAH | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ONWER | ||||||||
| AuthorizedOfficialTelephone: | 8174495235 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
| NPICertificationDate: | 04/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.