Wanderist Behavioral Health PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

WANDERIST BEHAVIORAL HEALTH PLLC

Practice address

2600 E Southern Ave Ste C3
Tempe, AZ 85282-7609

Phone

(626) 515-8875

NPI assigned

Nov 14, 2024

Organization subpart

No

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

Authorized official

Name

Nicole Carlson, LCSW, PMHNP-BCNPI 1427556240

Title

Psychiatric Nurse Practitioner

Phone

(626) 515-8875

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicole Carlson, LCSW, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Tempe, AZ
  • NPI 1427556240

  Clinical

  NPD Authorized official

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

{
    "created_epoch": "1731542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731542400000",
    "number": "1295559441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 E SOUTHERN AVE STE C3",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827609",
            "telephone_number": "626-515-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 E SOUTHERN AVE STE C3",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827609",
            "telephone_number": "626-515-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WANDERIST BEHAVIORAL HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-14",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "PSYCHIATRIC NURSE PRACTITIONER",
        "authorized_official_telephone_number": "626-515-8875",
        "authorized_official_credential": "LCSW, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Walsh
• Sophie Walsh
• Lynda Walter
• Keith Montgomery Walton, PTA
• Zack Walton, DMD
• Eva Yihui Wang, FNP
• Ashley Meghan Wanzer, PA-C
• Jeffrey P Ward, D.D.S.
• Milissa Ward
• Paula F Ware, M.C.

• Psychiatric/Mental Health Nurse Practitioner in Tempe, AZ
• Providers in Tempe, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.