Healthcare Provider Details

I. General information

NPI: 1881400133
Provider Name (Legal Business Name): DISCOVERY AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10149 N 92ND ST STE 103
SCOTTSDALE AZ
85258-4557
US

IV. Provider business mailing address

3616 W WALDEN CT
ANTHEM AZ
85086-6020
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-9913
  • Fax:
Mailing address:
  • Phone: 480-677-9913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEIDI BROUELETTE
Title or Position: OWNER/ FOUNDER
Credential: MA. LPC
Phone: 480-677-9913