MEDICARE: WHOLE CHILD SUCCESS THERAPEUTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1316803851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE CHILD SUCCESS THERAPEUTICS LLC

Provider Business Mailing Address
First Line	:	10757 N 55TH DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-3880
Country	:	US
Telephone Number	:	602-615-6085
Fax Number	:

Provider Business Practice Location Address
First Line	:	10757 N 55TH DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-3880
Country	:	US
Telephone Number	:	602-615-6085
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICAELA MILLER
Credential	:
Telephone Number	:	602-615-6085

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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