| Fourth Wall Wellness Llc | |
|
6281 N Oracle Rd Unit 35582 Tucson AZ 85704-5516 | |
| (720) 232-7784 | |
| Not Available |
| Full Name | Fourth Wall Wellness Llc |
|---|---|
| Speciality | Nurse Practitioner - Psychiatric/mental Health |
| Location | 6281 N Oracle Rd Unit 35582, Tucson, Arizona |
| Authorized Official Name and Position | Aurora Thrush (MEMBER) |
| Authorized Official Contact | 7202327784 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fourth Wall Wellness Llc 8327 N Verde Catalina Dr Tucson AZ 85704-6423 Ph: (720) 232-7784 | Fourth Wall Wellness Llc 6281 N Oracle Rd Unit 35582 Tucson AZ 85704-5516 Ph: (720) 232-7784 |
| NPI Number | 1124869581 |
|---|---|
| Provider Enumeration Date | 06/01/2024 |
| Last Update Date | 06/01/2024 |
| Certification Date | 06/01/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124869581 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
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