Healthcare Provider Details

I. General information

NPI: 1467343517
Provider Name (Legal Business Name): CHANNELS OF HEALING MED CLINIC & SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W ELLIOT RD
GILBERT AZ
85233-5102
US

IV. Provider business mailing address

21168 E OCOTILLO RD
QUEEN CREEK AZ
85142-8175
US

V. Phone/Fax

Practice location:
  • Phone: 480-908-4049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIANA ARCHIBONG
Title or Position: OWNER
Credential:
Phone: 480-908-4049