Provider Demographics
NPI:1215742432
Name:CREDO MINDS BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:CREDO MINDS BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-865-9082
Mailing Address - Street 1:1050 E SOUTHERN AVE STE F5
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5421
Mailing Address - Country:US
Mailing Address - Phone:602-865-9082
Mailing Address - Fax:
Practice Address - Street 1:1050 E SOUTHERN AVE STE F5
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5421
Practice Address - Country:US
Practice Address - Phone:602-865-9082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health