NPIMap

Organization Active NPI

Mindfully Integrated Health PLLC

  • Psychiatry Physician
  • Scottsdale, AZ
National Provider Identifier
1083102826
Registry record updated Apr 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MINDFULLY INTEGRATED HEALTH PLLC
Practice address
8585 E Hartford Dr Ste 103
Scottsdale, AZ 85255-5472
Phone
(480) 562-6600
Fax
(480) 562-6606
NPI assigned
Apr 26, 2018
Last updated
Apr 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sarah Wicklund, MDNPI 1629241179
Title
Medical Director
Phone
(480) 562-6600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Psychiatry Physician 2084P0800X NU Primary
Multi-Specialty Clinic/Center 261QM1300X NU
Physician Assistant 363A00000X NU

Addresses

Primary practice location

8585 E Hartford Dr Ste 103
Scottsdale, AZ 85255-5472

Mailing address

PO Box 11616
Glendale, AZ 85318-1616
Phone (480) 562-6600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180803001521 AZ Part B Supplier - Clinic/Group Practice 7113275397 Receives reassigned benefits from 7 practitioners
Practice locations: Scottsdale, AZ

National Provider Directory

National Provider Directory

Locations

8585 E Hartford Dr
Ste 103
Scottsdale, AZ 85255
Phone (480) 562-6600

8585 E Hartford Dr
Ste 400
Scottsdale, AZ 85255
Phone (480) 454-5598

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618963200000",
    "number": "1083102826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11616",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853181616",
            "telephone_number": "480-562-6600",
            "fax_number": "480-562-6606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8585 E HARTFORD DR STE 103",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852555472",
            "telephone_number": "480-562-6600",
            "fax_number": "480-562-6606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFULLY INTEGRATED HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-26",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A",
        "authorized_official_last_name": "WICKLUND",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "480-562-6600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsdale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.