Healthcare Provider Details

I. General information

NPI: 1568374130
Provider Name (Legal Business Name): STRIVE WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 N BLACK CANYON HWY STE C1
PHOENIX AZ
85009-2910
US

IV. Provider business mailing address

1622 N BLACK CANYON HWY STE C1
PHOENIX AZ
85009-2910
US

V. Phone/Fax

Practice location:
  • Phone: 602-905-9072
  • Fax:
Mailing address:
  • Phone: 602-905-9072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE SHORT
Title or Position: OWNER/ADMINISTRATOR
Credential: BHT
Phone: 602-905-9072