Healthcare Provider Details

I. General information

NPI: 1164337978
Provider Name (Legal Business Name): INCLUSIVE MENTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 W HASAN DR
LAVEEN AZ
85339-1960
US

IV. Provider business mailing address

1628 E SOUTHERN AVE STE 9697
TEMPE AZ
85282-5782
US

V. Phone/Fax

Practice location:
  • Phone: 480-532-8214
  • Fax:
Mailing address:
  • Phone: 480-743-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: VICKEY LYNN SIMMONS-HART
Title or Position: OWNER/OPERATOR
Credential: LPC-S
Phone: 480-532-8214