Provider Demographics
NPI:1336807411
Name:SIMPLY SERENE BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:SIMPLY SERENE BEHAVIORAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NDUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:NP-DNP
Authorized Official - Phone:602-756-9798
Mailing Address - Street 1:14844 S 30TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8714
Mailing Address - Country:US
Mailing Address - Phone:508-615-7980
Mailing Address - Fax:
Practice Address - Street 1:939 E IMPALA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6619
Practice Address - Country:US
Practice Address - Phone:602-756-9798
Practice Address - Fax:480-546-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty