Healthcare Provider Details

I. General information

NPI: 1306755517
Provider Name (Legal Business Name): THE HEALTHY PLACE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3158 NORTH CLANTON ST
BUCKEYE AZ
85396
US

IV. Provider business mailing address

784 S CLEARWATER LOOP # 4507
POST FALLS ID
83854-9599
US

V. Phone/Fax

Practice location:
  • Phone: 208-848-4987
  • Fax: 602-563-8218
Mailing address:
  • Phone: 208-848-4987
  • Fax: 602-563-8218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TYLER ANDERSON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 586-612-0476