SOUTH MOUNTAIN FAMILY PSYCHIATRY, LLC
NPI 1336788868
Nurse Practitioner - Psychiatric/Mental Health in Phoenix, AZ

Q: What is South Mountain Family Psychiatry, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Active since January 01, 2020

11022 S 51ST ST STE 250, PHOENIX, AZ 85044(480) 939-6137(602) 429-8445 Get Directions Write a Review

NPPES record last updated: June 21, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 21, 2021, Jul 24, 2020, Jan 1, 2020 (3 updates tracked since 2020).

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About South Mountain Family Psychiatry, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTH MOUNTAIN FAMILY PSYCHIATRY, LLC (NPI 1336788868) is a healthcare organization registered as a psychiatric/mental health in Phoenix, Arizona and active in the NPI registry since January 2020. The organization lists John W Wilson, Business Manager, as its authorized official.

NPPES Registry Identity

NPI1336788868

Entity TypeOrganization

Primary Taxonomy363LP0808X

Legal Business NameSOUTH MOUNTAIN FAMILY PSYCHIATRY, LLC

Location Address11022 S 51ST ST STE 250Phoenix, AZ 85044-4308

Mailing Address11022 S 51st St Ste 250Phoenix, AZ 85044-4308 · (480) 939-6137 · Fax (602) 429-8445

Phone(480) 939-6137

Fax(602) 429-8445

Organization SubpartNo

Authorized OfficialJohn W WilsonBusiness Manager · (602) 418-9105

Enumeration DateJanuary 1, 2020

Last NPPES UpdateJune 21, 20213 updates tracked since enumeration

NPPES CertifiedJune 21, 2021

✔ NPI 1336788868 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

11022 S 51ST ST STE 250, Phoenix, AZ 85044

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

South Mountain Family Psychiatry, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 6 clinicians reassign Medicare billing to South Mountain Family Psychiatry, LLC, which bills Medicare for the services they deliver. Of these, 5 practice at this address. They are listed nearest first.