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NPI Code Detail

MEDICARE: FIT MIND WELLNESS, LLC

MEDICARE: FIT MIND WELLNESS, 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1871118919
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIT MIND WELLNESS, LLC
Provider Business Mailing Address
First Line : 34975 N NORTH VALLEY PKWY STE 152
Second Line :
City : PHOENIX
State : AZ
Zip : 85086-4032
Country : US
Telephone Number : 480-525-7091
Fax Number :
Provider Business Practice Location Address
First Line : 34975 N NORTH VALLEY PKWY STE 152
Second Line :
City : PHOENIX
State : AZ
Zip : 85086-4032
Country : US
Telephone Number : 480-525-7091
Fax Number :
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : DR. MARLENA GONZALES-GABALDON
Credential : DBH, LPC
Telephone Number : 480-292-3219
Provider Enumeration Date : 06/15/2020
Last Update Date : 06/15/2020

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Directions to “FIT MIND WELLNESS, LLC ” Practice Location

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