Healthcare Provider Details

I. General information

NPI: 1366222622
Provider Name (Legal Business Name): MANIFEST JOY LIFE GUIDANCE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 N SWAN RD STE 112
TUCSON AZ
85712-4051
US

IV. Provider business mailing address

1661 N SWAN RD
TUCSON AZ
85712-4042
US

V. Phone/Fax

Practice location:
  • Phone: 520-372-2019
  • Fax:
Mailing address:
  • Phone: 520-409-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY AHMADI
Title or Position: OWNER/LEAD THERAPIST
Credential: LMFT
Phone: 520-372-2022