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General NPI Number Information
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NPI Number | 1306594031
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Entity Type | Organization
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Legal Business Name | BLACKHORSE THERAPY AND WELLNESS LLC
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Dates
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Enumeration Date | 03/11/2022
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 2425 S 121ST DR
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City | AVONDALE
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State | AZ
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Zip | 85323-7667
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Country | US
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Telephone | 602-350-1648
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 214
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City | AVONDALE
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State | AZ
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Zip | 85323-0080
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Country | US
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Telephone | 602-350-1648
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FLORIANN BLACKHORSE
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Credential | LCSW
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Telephone | 602-350-1648
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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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