=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801623228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING HARTZE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2024
-----------------------------------------------------
Last Update Date | 09/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23460 N 19TH AVE STE 220
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85027-2170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-989-8899
-----------------------------------------------------
Fax | 602-900-0969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17505 N 79TH AVE STE 105
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85308-8724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-292-4477
-----------------------------------------------------
Fax | 602-900-0969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | JANUARY HARTZE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 602-292-4477
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------