Provider Demographics
NPI:1699448910
Name:MENTAL HEALTH AWARENESS UTOPIA
Entity type:Organization
Organization Name:MENTAL HEALTH AWARENESS UTOPIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NP
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:DENIE
Authorized Official - Last Name:JOHNSON-WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, DNP
Authorized Official - Phone:520-635-6578
Mailing Address - Street 1:44563 W GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-8889
Mailing Address - Country:US
Mailing Address - Phone:520-635-6578
Mailing Address - Fax:229-518-2549
Practice Address - Street 1:44563 W GARDEN LN
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8889
Practice Address - Country:US
Practice Address - Phone:520-635-6578
Practice Address - Fax:229-518-2549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty