Healthcare Provider Details

I. General information

NPI: 1932858081
Provider Name (Legal Business Name): ARIZONA HOLISTIC HEALING AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 S ALMA SCHOOL RD STE A203
MESA AZ
85210-3066
US

IV. Provider business mailing address

1930 S ALMA SCHOOL RD STE A203
MESA AZ
85210-3066
US

V. Phone/Fax

Practice location:
  • Phone: 480-360-2172
  • Fax:
Mailing address:
  • Phone: 480-256-8566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
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: AARON DAVID HALLSTROM
Title or Position: CO-OWNER
Credential: PHD, LIAC
Phone: 480-256-8566