Healthcare Provider Details

I. General information

NPI: 1548010606
Provider Name (Legal Business Name): WHOLESOME THERAPY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 E VALLEY AUTO DR STE 201
MESA AZ
85206-4609
US

IV. Provider business mailing address

4510 E BANNER GATEWAY DR APT 3062
MESA AZ
85206-4759
US

V. Phone/Fax

Practice location:
  • Phone: 320-305-6717
  • Fax:
Mailing address:
  • Phone: 320-305-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ALISON RENAE NIESEN
Title or Position: FOUNDER
Credential: LCSW, LICSW
Phone: 320-305-3883