Healthcare Provider Details

I. General information

NPI: 1851215206
Provider Name (Legal Business Name): NOVA WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9393 N 90TH ST STE 102-722
SCOTTSDALE AZ
85258-5040
US

IV. Provider business mailing address

9393 N 90TH ST STE 102-722
SCOTTSDALE AZ
85258-5040
US

V. Phone/Fax

Practice location:
  • Phone: 602-583-5714
  • Fax:
Mailing address:
  • Phone: 602-583-5714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KIARA. GRAHAM
Title or Position: MANAGING MEMBER
Credential:
Phone: 602-583-5714