Provider Demographics
NPI:1679395297
Name:SEQUOIA MENTAL WELLNESS PLLC
Entity type:Organization
Organization Name:SEQUOIA MENTAL WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DINNELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:480-992-4221
Mailing Address - Street 1:1270 W FEVER TREE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7684
Mailing Address - Country:US
Mailing Address - Phone:480-992-4221
Mailing Address - Fax:480-992-7445
Practice Address - Street 1:1270 W FEVER TREE AVE
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7684
Practice Address - Country:US
Practice Address - Phone:480-992-4221
Practice Address - Fax:480-992-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health