Healthcare Provider Details

I. General information

NPI: 1316803851
Provider Name (Legal Business Name): WHOLE CHILD SUCCESS THERAPEUTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10757 N 55TH DR
GLENDALE AZ
85304-3880
US

IV. Provider business mailing address

10757 N 55TH DR
GLENDALE AZ
85304-3880
US

V. Phone/Fax

Practice location:
  • Phone: 602-615-6085
  • Fax:
Mailing address:
  • Phone: 602-615-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICAELA MILLER
Title or Position: OWNER
Credential:
Phone: 602-615-6085