Healthcare Provider Details

I. General information

NPI: 1659162691
Provider Name (Legal Business Name): PURE POTENTIAL MENTAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 E FORT LOWELL RD STE 5
TUCSON AZ
85719-2358
US

IV. Provider business mailing address

11201 N TATUM BLVD STE 300
PHOENIX AZ
85028-6039
US

V. Phone/Fax

Practice location:
  • Phone: 520-230-5262
  • Fax:
Mailing address:
  • Phone: 415-278-1574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CASSIE MARIE MOORES KRISTENSEN
Title or Position: FOUNDER
Credential: PMHNP-BC, FNP-BC
Phone: 415-278-1574