| Blooming Desert Prickly Llc | |
|
909 W Grove Pkwy Apt 2029 Tempe AZ 85283-8422 | |
| (775) 287-9463 | |
| Not Available |
| Full Name | Blooming Desert Prickly Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 909 W Grove Pkwy Apt 2029, Tempe, Arizona |
| Authorized Official Name and Position | Laryssa Ikehara (OWNER) |
| Authorized Official Contact | 7752879463 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blooming Desert Prickly Llc 909 W Grove Pkwy Apt 2029 Tempe AZ 85283-8422 Ph: (775) 287-9463 | Blooming Desert Prickly Llc 909 W Grove Pkwy Apt 2029 Tempe AZ 85283-8422 Ph: (775) 287-9463 |
| NPI Number | 1114667987 |
|---|---|
| Provider Enumeration Date | 03/30/2022 |
| Last Update Date | 03/30/2022 |
| Certification Date | 03/30/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114667987 | NPI | - | NPPES |
| 000000000 | Other | NONE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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