Healthcare Provider Details

I. General information

NPI: 1376490334
Provider Name (Legal Business Name): ABUSWELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3669 E BOOT TRACK TRL
GILBERT AZ
85296-0695
US

IV. Provider business mailing address

3669 E BOOT TRACK TRL
GILBERT AZ
85296-0695
US

V. Phone/Fax

Practice location:
  • Phone: 860-335-3559
  • Fax:
Mailing address:
  • Phone: 860-335-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA M BUSWELL
Title or Position: PRINCIPAL
Credential: LMFT
Phone: 860-335-3559