Healthcare Provider Details

I. General information

NPI: 1629914239
Provider Name (Legal Business Name): PIERCED VALLEY THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1273 S HOWARD DR
YUMA AZ
85364
US

IV. Provider business mailing address

PO BOX 272
YUMA AZ
85366-2312
US

V. Phone/Fax

Practice location:
  • Phone: 928-295-0667
  • Fax:
Mailing address:
  • Phone: 928-295-0667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: PHYLICIA JOY HENDERSON
Title or Position: OWNER, FOUNDER, THERAPIST
Credential: LAC
Phone: 928-295-0667