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General NPI Number Information
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NPI Number | 1295621464
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Entity Type | Organization
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Legal Business Name | XOLA BEHAVIORAL HEALTH AND WELLNESS CENTER
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 637 W OCOTILLO ST
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City | CASA GRANDE
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State | AZ
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Zip | 85122-2210
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Country | US
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Telephone | 480-242-8539
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Fax |
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Provider Business Mailing Address
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Address Line | 637 W OCOTILLO ST
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City | CASA GRANDE
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State | AZ
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Zip | 85122-2210
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Country | US
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Telephone | 480-242-8539
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | CARLOS LASSITER
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Credential |
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Telephone | 480-242-8539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 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 #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 364SP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 364SP0810X
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Taxonomy Name | Child & Family Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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