| Vividly Vitality Mentoring & Counsel, Llc | |
|
920 S Terrace Rd Unit 5035 Tempe AZ 85281-3805 | |
| (480) 482-8647 | |
| (480) 936-0000 |
| Full Name | Vividly Vitality Mentoring & Counsel, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 920 S Terrace Rd Unit 5035, Tempe, Arizona |
| Authorized Official Name and Position | Talencia Arlicia Walker (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4804848647 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vividly Vitality Mentoring & Counsel, Llc 920 S Terrace Rd Unit 5035 Tempe AZ 85281-3805 Ph: (480) 482-8647 | Vividly Vitality Mentoring & Counsel, Llc 920 S Terrace Rd Unit 5035 Tempe AZ 85281-3805 Ph: (480) 482-8647 |
| NPI Number | 1154089696 |
|---|---|
| Provider Enumeration Date | 12/01/2021 |
| Last Update Date | 12/01/2021 |
| Certification Date | 12/01/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154089696 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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