Healthcare Provider Details

I. General information

NPI: 1639914591
Provider Name (Legal Business Name): SAGUARO INTEGRATED WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 E VALLEY AUTO DR STE 208
MESA AZ
85206-4612
US

IV. Provider business mailing address

4115 E VALLEY AUTO DR STE 208
MESA AZ
85206-4612
US

V. Phone/Fax

Practice location:
  • Phone: 480-229-8140
  • Fax:
Mailing address:
  • Phone: 480-229-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE GARCIA
Title or Position: OWNER
Credential: LPC
Phone: 480-229-8140