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General NPI Number Information
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NPI Number | 1437893443
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Entity Type | Organization
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Legal Business Name | PUSH WELLNESS LLC
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Dates
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Enumeration Date | 04/25/2022
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 2821 N 33RD AVE STE 9
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City | PHOENIX
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State | AZ
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Zip | 85009-1425
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Country | US
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Telephone | 281-216-2620
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Fax |
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Provider Business Mailing Address
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Address Line | 2821 N 33RD AVE STE 9
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City | PHOENIX
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State | AZ
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Zip | 85009-1425
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Country | US
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Telephone | 281-216-2620
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | SHEENA NAYLOR
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Credential |
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Telephone | 281-216-2620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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 | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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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 | 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 #5
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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 #6
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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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