Healthcare Provider Details
I. General information
NPI: 1649069683
Provider Name (Legal Business Name): RESILIENCE WELLNESS CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
15150 W PARK PL FL 2
GOODYEAR AZ
85395-2385
US
IV. Provider business mailing address
15150 W PARK PL FL 2
GOODYEAR AZ
85395-2385
US
V. Phone/Fax
- Phone: 480-955-1125
- Fax:
- Phone: 480-955-1125
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QM0850X |
| Taxonomy | Adult Mental Health Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MARIA
WILDEY
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LCSW
Phone: 480-465-1167