MEDICARE: HEAL VALLEY CLINIC LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1740967249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAL VALLEY CLINIC LLC

Provider Business Mailing Address
First Line	:	1737 E BASELINE RD
Second Line	:	105
City	:	GILBERT
State	:	AZ
Zip	:	85233
Country	:	US
Telephone Number	:	857-264-7049
Fax Number	:

Provider Business Practice Location Address
First Line	:	1737 E BASELINE RD
Second Line	:	105
City	:	GILBERT
State	:	AZ
Zip	:	85233
Country	:	US
Telephone Number	:	857-264-7049
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LANDRY KWIZERA
Credential	:	RN
Telephone Number	:	857-264-7049

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	06/28/2023

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Directions to “HEAL VALLEY CLINIC LLC ” Practice Location

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