NPIMap

Organization Active NPI

Desert Clover Psychiatry, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1316693419
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
DESERT CLOVER PSYCHIATRY, LLC
Practice address
2601 N 3Rd St Ste 205
Phoenix, AZ 85004-1145
Phone
(602) 492-2121
NPI assigned
Feb 28, 2022
Last updated
Oct 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Justin Kodysz
Title
Chief Operations Officer
Phone
(602) 492-2121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

2601 N 3Rd St Ste 205
Phoenix, AZ 85004-1145

Mailing address

2601 N 3Rd St Ste 205
Phoenix, AZ 85004-1145
Phone (602) 492-2121

National Provider Directory

National Provider Directory

Locations

2601 N 3rd St
Ste 108
Phoenix, AZ 85004
Phone (602) 830-8814

2601 N 3rd St
Ste 205
Phoenix, AZ 85004
Phone (480) 494-3164

Practitioners & affiliated clinicians

Practitioners 4

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": "1646006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1316693419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 N 3RD ST STE 205",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041145",
            "telephone_number": "602-492-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 N 3RD ST STE 205",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041145",
            "telephone_number": "602-492-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT CLOVER PSYCHIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-28",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "KODYSZ",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "602-492-2121"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; 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.