Healthcare Provider Details

I. General information

NPI: 1942013420
Provider Name (Legal Business Name): AZ HOLISTIC ANXIETY TREATMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10245 E VIA LINDA STE 225
SCOTTSDALE AZ
85258-5345
US

IV. Provider business mailing address

1525 S HIGLEY RD STE 104
GILBERT AZ
85296-5045
US

V. Phone/Fax

Practice location:
  • Phone: 480-462-5272
  • Fax:
Mailing address:
  • Phone: 480-462-5272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMIE GUSTAFSON
Title or Position: PMHNP-BC
Credential: APRN
Phone: 480-462-5272