Provider Demographics
NPI:1215792338
Name:CACTUS GARDEN MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:CACTUS GARDEN MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:EISEMANN-ASTONE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:480-913-5872
Mailing Address - Street 1:7165 E UNIVERSITY DR STE 155
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-6412
Mailing Address - Country:US
Mailing Address - Phone:480-913-5872
Mailing Address - Fax:602-848-3105
Practice Address - Street 1:7165 E UNIVERSITY DR STE 155
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-6412
Practice Address - Country:US
Practice Address - Phone:480-913-5872
Practice Address - Fax:602-848-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty