Az Sober Living & Behavioral Health Group, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

AZ SOBER LIVING & BEHAVIORAL HEALTH GROUP, LLC

Practice address

2920 N 24TH Ave Ste 120
Phoenix, AZ 85015-5958

Phone

(623) 302-9213

NPI assigned

Jul 26, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Waldeck Charles, MD

Title

Medical Director

Phone

(602) 315-7033

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Nirva M Jean-Baptiste, A.M.H.N.P

  • Psychiatric/Mental Health Nurse Practitioner
  • Mesa, AZ
  • NPI 1407279771
  NPD (past)
• Lynn Cooper Johnson, FNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Flagstaff, AZ
  • NPI 1124318159
  NPD (past)

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

{
    "created_epoch": "1501027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1538683081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 N 24TH AVE STE 150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850155959",
            "telephone_number": "623-302-9213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 N 24TH AVE STE 120",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850155958",
            "telephone_number": "623-302-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZ SOBER LIVING & BEHAVIORAL HEALTH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-26",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "WALDECK",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "602-315-7033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Psychiatry Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.