Healthcare Provider Details

I. General information

NPI: 1215538806
Provider Name (Legal Business Name): LIFE N LOVE WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S LAKESHORE DR STE 101
TEMPE AZ
85282-7156
US

IV. Provider business mailing address

4050 E COTTON CENTER BLVD STE 77
PHOENIX AZ
85040-8865
US

V. Phone/Fax

Practice location:
  • Phone: 480-594-3570
  • Fax:
Mailing address:
  • Phone: 480-594-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOSHUA FARRAKHAN
Title or Position: CEO
Credential:
Phone: 480-594-3570