NPIMap

Organization Active NPI

Lifewell Behavioral Wellness

  • Community/Behavioral Health Agency
  • Phoenix, AZ
National Provider Identifier
1730474693
Registry record updated May 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
OTC6575 Issued in AZ
Legal business name
LIFEWELL BEHAVIORAL WELLNESS
Practice address
10844 N 23Rd Ave Ste 100
Phoenix, AZ 85029-4947
Phone
(602) 808-2800
Fax
(602) 262-2111
NPI assigned
Jun 17, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2021

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

Authorized official

Name
Doris Vaught
Title
President /Ceo
Phone
(602) 599-5420

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X OTC6575 AZ Primary

Addresses

Primary practice location

10844 N 23Rd Ave Ste 100
Phoenix, AZ 85029-4947

Mailing address

202 E Earll Drive
Suite 200
Phoenix, AZ 85012-2647
Phone (602) 808-2800

Other identifiers 1

IdentifierTypeStateIssuer
617183MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
Lifewell19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1308268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622160000000",
    "number": "1730474693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E EARLL DRIVE",
            "address_2": "SUITE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122647",
            "telephone_number": "602-808-2800",
            "fax_number": "602-808-2755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10844 N 23RD AVE STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294947",
            "telephone_number": "602-808-2800",
            "fax_number": "602-262-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEWELL BEHAVIORAL WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-17",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A",
        "authorized_official_last_name": "VAUGHT",
        "authorized_official_first_name": "DORIS",
        "authorized_official_title_or_position": "PRESIDENT /CEO",
        "authorized_official_telephone_number": "602-599-5420"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "OTC6575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "617183",
            "state": "AZ"
        }
    ],
    "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 May 28, 2021; 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.