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General NPI Number Information
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NPI Number | 1487574083
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Entity Type | Organization
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Legal Business Name | UNTAMED ROSE THERAPY LLC
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Dates
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Enumeration Date | 07/16/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 1324 E STIRRUP LN
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-3235
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Country | US
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Telephone | 480-331-1815
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 S HIGLEY RD STE 104-1076
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City | GILBERT
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State | AZ
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Zip | 85296-4795
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Country | US
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Telephone | 480-331-1815
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BIANCA CHAVEZ
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Credential | LPC
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Telephone | 480-331-1815
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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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