MEDICARE: HEALTHY HABITS THERAPY, 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1568034809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY HABITS THERAPY, LLC

Provider Business Mailing Address
First Line	:	1934 E CAMELBACK RD STE 120-451
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4126
Country	:	US
Telephone Number	:	562-713-5995
Fax Number	:

Provider Business Practice Location Address
First Line	:	2439 E MINNEZONA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4925
Country	:	US
Telephone Number	:	562-713-5995
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRITANY JAMES
Credential	:
Telephone Number	:	562-713-5995

Provider Enumeration Date	:	07/15/2021
Last Update Date	:	07/15/2021

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