Healthcare Provider Details

I. General information

NPI: 1831002880
Provider Name (Legal Business Name): WEATHERED REINS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 VIA DE LA REINA
SIERRA VISTA AZ
85650-8573
US

IV. Provider business mailing address

PO BOX 3
HEREFORD AZ
85615-0003
US

V. Phone/Fax

Practice location:
  • Phone: 520-356-9231
  • Fax:
Mailing address:
  • Phone: 520-356-9231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIARA RODRIGUEZ
Title or Position: OWNER
Credential: LPC
Phone: 520-356-9231