Provider Demographics
NPI:1174201941
Name:CEREBELLUM MENTAL HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:CEREBELLUM MENTAL HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NP
Authorized Official - Prefix:
Authorized Official - First Name:JALILI
Authorized Official - Middle Name:
Authorized Official - Last Name:ARABI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:602-626-4708
Mailing Address - Street 1:2473 S HIGLEY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1103
Mailing Address - Country:US
Mailing Address - Phone:602-626-4708
Mailing Address - Fax:
Practice Address - Street 1:507 W COMSTOCK DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5803
Practice Address - Country:US
Practice Address - Phone:602-626-4708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty