Healthcare Provider Details

I. General information

NPI: 1487574083
Provider Name (Legal Business Name): UNTAMED ROSE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 E STIRRUP LN
SAN TAN VALLEY AZ
85143-3235
US

IV. Provider business mailing address

1525 S HIGLEY RD STE 104-1076
GILBERT AZ
85296-4795
US

V. Phone/Fax

Practice location:
  • Phone: 480-331-1815
  • Fax:
Mailing address:
  • Phone: 480-331-1815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: BIANCA CHAVEZ
Title or Position: OWNER
Credential: LPC
Phone: 480-331-1815