WISTERIA MENTAL HEALTH & WELLNESS CENTER PLLC – NPI #1194413419
Psychiatry & Neurology

Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence.

Health Care Provider Taxonomy Code for Psychiatry & Neurology

WISTERIA MENTAL HEALTH & WELLNESS CENTER PLLC is a psychiatry & neurologist located in PHOENIX, AZ. NPPES has assigned the NPI number 1194413419 to WISTERIA MENTAL HEALTH & WELLNESS CENTER PLLC on April 25, 2023. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 2084P0804X from the Health Care Provider Taxonomy code set, which is classified as Psychiatry & Neurology, specializing in Child & Adolescent Psychiatry

The NPI profile was last updated on Mar 14, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for WISTERIA MENTAL HEALTH & WELLNESS CENTER PLLC below.

NPI Profile for
WISTERIA MENTAL HEALTH & WELLNESS CENTER PLLC

NPI Number
1194413419
Enumeration Date

(more than 3 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
WISTERIA MENTAL HEALTH & WELLNESS CENTER PLLC
Primary location
301 W ECHO LN
PHOENIX, AZ 85021-5554
Phone: (480) 399-8455 Fax: (866) 845-1832
Mailing address
14802 N 18TH PL
PHOENIX, AZ 85022-3925
Phone: (480) 399-8455 Fax: (866) 845-1832
Organization Subpart
No
Authorized Official
ROBERTO BRACAMONTE VALENCIA
CEO
Phone: (602) 350-3046
Updated
Certification Date
Mar 14, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2084P0804X
- Psychiatry & Neurology / Child & Adolescent Psychiatry (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.