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General NPI Number Information
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NPI Number | 1164337978
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Entity Type | Organization
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Legal Business Name | INCLUSIVE MENTAL WELLNESS LLC
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Dates
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Enumeration Date | 08/17/2026
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Last Update Date | 08/17/2026
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Provider Practice Location Address
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Address Line | 4509 W HASAN DR
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City | LAVEEN
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State | AZ
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Zip | 85339-1960
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Country | US
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Telephone | 480-532-8214
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Fax |
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Provider Business Mailing Address
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Address Line | 1628 E SOUTHERN AVE STE 9697
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City | TEMPE
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State | AZ
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Zip | 85282-5782
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Country | US
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Telephone | 480-743-5711
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | VICKEY LYNN SIMMONS-HART
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Credential | LPC-S
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Telephone | 480-532-8214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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