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General NPI Number Information
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NPI Number | 1073004339
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Entity Type | Organization
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Legal Business Name | TRIBE WELLNESS GROUP PLLC
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 549 S MAIN ST
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City | COTTONWOOD
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State | AZ
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Zip | 86326-3902
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Country | US
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Telephone | 928-202-9187
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Fax | 928-202-4666
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Provider Business Mailing Address
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Address Line | 549 S MAIN ST
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City | COTTONWOOD
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State | AZ
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Zip | 86326-3902
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Country | US
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Telephone | 928-202-9187
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Fax | 928-202-4666
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KELLY WEATHERSBY
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Credential |
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Telephone | 928-202-9187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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