Healthcare Provider Details

I. General information

NPI: 1629560941
Provider Name (Legal Business Name): WOMEN'S HEALTH INNOVATIONS OF ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 S HIGLEY RD STE 113
GILBERT AZ
85296-4789
US

IV. Provider business mailing address

1355 S HIGLEY RD STE 113
GILBERT AZ
85296-4789
US

V. Phone/Fax

Practice location:
  • Phone: 480-339-7119
  • Fax: 480-855-7991
Mailing address:
  • Phone: 480-339-7119
  • Fax: 480-855-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberMED7600
License Number State

VIII. Authorized Official

Name: MICHELLE LACY
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 480-339-7119