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General NPI Number Information
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NPI Number | 1568934107
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Entity Type | Organization
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Legal Business Name | EARTHWALK WELLNESS GROUP, LLC
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 14050 NORTH 83RD AVENUE SUITE 290
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City | PEORIA
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State | AZ
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Zip | 85381
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Country | US
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Telephone | 480-349-1031
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Fax | 623-321-1565
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Provider Business Mailing Address
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Address Line | 7373 EAST DOUBLETREE RANCH SUITE 165
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City | SCOTTSDALE
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State | AZ
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Zip | 85258
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Country | US
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Telephone | 480-664-7478
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Fax | 602-297-6890
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KYRIE THOMPSON
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Credential |
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Telephone | 480-349-1031
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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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