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General NPI Number Information
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NPI Number | 1962128249
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Entity Type | Organization
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Legal Business Name | ANZA WELLNESS & RECOVERY SERVICES, PLLC
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Dates
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Enumeration Date | 10/18/2022
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 15150 W PARK PL 2ND FLOOR, SUITE 2031
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City | GOODYEAR
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State | AZ
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Zip | 85395
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Country | US
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Telephone | 480-999-8200
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Fax | 480-800-2212
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Provider Business Mailing Address
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Address Line | 412 E SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282-5212
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Country | US
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Telephone | 651-800-5900
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Fax | 480-800-2212
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Authorized Official
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Title or Position | OWNER/MEMBER MANAGER
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Name | CALEB M REID
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Credential | PMHNP
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Telephone | 480-999-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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