| Blooming Agave Wellness Llc | |
|
4117 N 17th St Phoenix AZ 85016-5921 | |
| (623) 239-2312 | |
| Not Available |
| Full Name | Blooming Agave Wellness Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 4117 N 17th St, Phoenix, Arizona |
| Authorized Official Name and Position | Joshua Phillips (THERAPIST/OWNER) |
| Authorized Official Contact | 9702608286 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blooming Agave Wellness Llc 16609 N 34th Pl Phoenix AZ 85032-2776 Ph: (970) 260-8286 | Blooming Agave Wellness Llc 4117 N 17th St Phoenix AZ 85016-5921 Ph: (623) 239-2312 |
| NPI Number | 1053144154 |
|---|---|
| Provider Enumeration Date | 08/23/2024 |
| Last Update Date | 08/23/2024 |
| Certification Date | 08/23/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053144154 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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