Healthcare Provider Details

I. General information

NPI: 1083102826
Provider Name (Legal Business Name): MINDFULLY INTEGRATED HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 E HARTFORD DR STE 103
SCOTTSDALE AZ
85255-5472
US

IV. Provider business mailing address

PO BOX 11616
GLENDALE AZ
85318-1616
US

V. Phone/Fax

Practice location:
  • Phone: 480-562-6600
  • Fax: 480-562-6606
Mailing address:
  • Phone: 480-562-6600
  • Fax: 480-562-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: SARAH WICKLUND
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 480-562-6600