=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801531074
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING WAREHOUSE COUNSELING AND THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2022
-----------------------------------------------------
Last Update Date | 05/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 N BROAD ST
-----------------------------------------------------
City | GLOBE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85501-2757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-685-1147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31620 N 55TH WAY
-----------------------------------------------------
City | CAVE CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85331-2465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-685-1147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ASERE DAVID MWARA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-685-1147
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0800X
-----------------------------------------------------
Taxonomy Name | Recovery Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------