MEDICARE: SUN PATH WHOLENESS 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1952099889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN PATH WHOLENESS LLC

Provider Business Mailing Address
First Line	:	405 E WETMORE RD STE 117-512
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-1717
Country	:	US
Telephone Number	:	520-375-9055
Fax Number	:	877-366-9491

Provider Business Practice Location Address
First Line	:	1961 N AVENIDA AZAHAR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-1660
Country	:	US
Telephone Number	:	520-375-9055
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. GREG LOEBEL
Credential	:	PHD
Telephone Number	:	520-375-9055

Provider Enumeration Date	:	04/27/2023
Last Update Date	:	01/10/2024

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Directions to “SUN PATH WHOLENESS LLC ” Practice Location

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