Healthcare Provider Details

I. General information

NPI: 1225792781
Provider Name (Legal Business Name): HEART OF WINGS FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8433 N BLACK CANYON HWY STE 184
PHOENIX AZ
85021-4859
US

IV. Provider business mailing address

8433 N BLACK CANYON HWY STE 184
PHOENIX AZ
85021-4859
US

V. Phone/Fax

Practice location:
  • Phone: 602-299-7255
  • Fax:
Mailing address:
  • Phone: 602-299-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: NAIIS LYNN VALDEZ-BAKER
Title or Position: CEO/OWNER
Credential:
Phone: 602-299-7255