MEDICARE: RESET WELLNESS & RECOVERY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1134926793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESET WELLNESS & RECOVERY LLC

Provider Business Mailing Address
First Line	:	1002 E MCDOWELL RD STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2624
Country	:	US
Telephone Number	:	470-493-7061
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 E MCDOWELL RD STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2624
Country	:	US
Telephone Number	:	470-493-7061
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASMINE S WALKER
Credential	:
Telephone Number	:	470-493-7061

Provider Enumeration Date	:	02/28/2025
Last Update Date	:	02/28/2025

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