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General NPI Number Information
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NPI Number | 1528938966
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Entity Type | Organization
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Legal Business Name | BLUE WATERS THERAPY AND WELLNESS LLC
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Dates
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Enumeration Date | 11/10/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 855 S CANCUN DR
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City | GILBERT
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State | AZ
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Zip | 85233-7503
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Country | US
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Telephone | 602-412-1551
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Fax |
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Provider Business Mailing Address
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Address Line | 855 S CANCUN DR
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City | GILBERT
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State | AZ
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Zip | 85233-7503
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Country | US
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Telephone | 480-685-0288
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JENNIFER HARTE QUINN
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Credential |
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Telephone | 480-685-0288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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