Provider Demographics
NPI:1073171153
Name:HEART SONG WELLNESS LLC
Entity Type:Organization
Organization Name:HEART SONG WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACKENZIE FAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:425-233-1732
Mailing Address - Street 1:8715 W UNION HILLS DR STE 111
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3031
Mailing Address - Country:US
Mailing Address - Phone:425-233-1732
Mailing Address - Fax:623-248-7737
Practice Address - Street 1:8715 W UNION HILLS DR STE 111
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3031
Practice Address - Country:US
Practice Address - Phone:425-233-1732
Practice Address - Fax:623-248-7737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073171153OtherNPI
1154445062OtherNPI