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General NPI Number Information
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NPI Number | 1366200123
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Entity Type | Organization
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Legal Business Name | AZ WHOLE HEART CONNECTION, LLC
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 6641 S KINGS RANCH RD STE 1
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City | GOLD CANYON
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State | AZ
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Zip | 85118-2924
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Country | US
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Telephone | 480-371-5883
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Fax |
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Provider Business Mailing Address
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Address Line | 9685 E PALERMO AVE
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City | GOLD CANYON
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State | AZ
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Zip | 85118-7019
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Country | US
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Telephone | 307-247-5359
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTIE ASHBECK
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Credential | LPC
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Telephone | 480-371-5883
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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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