Healthcare Provider Details

I. General information

NPI: 1659159325
Provider Name (Legal Business Name): INCLUSION WELLNESS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 S ALMA SCHOOL RD STE 105
MESA AZ
85210-4013
US

IV. Provider business mailing address

2345 S ALMA SCHOOL RD STE 105
MESA AZ
85210-4013
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-6320
  • Fax:
Mailing address:
  • Phone: 480-712-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN VOLDEN
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 480-818-6608