Provider Demographics
| NPI: | 1295621464 |
|---|---|
| Name: | XOLA BEHAVIORAL HEALTH AND WELLNESS CENTER |
| Entity type: | Organization |
| Organization Name: | XOLA BEHAVIORAL HEALTH AND WELLNESS CENTER |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | MANAGING DIRECTOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | CARLOS |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | LASSITER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 480-242-8539 |
| Mailing Address - Street 1: | 637 W OCOTILLO ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CASA GRANDE |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85122-2210 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 480-242-8539 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 637 W OCOTILLO ST |
| Practice Address - Street 2: | |
| Practice Address - City: | CASA GRANDE |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85122-2210 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 480-242-8539 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2025-06-16 |
| Last Update Date: | 2025-06-17 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TP0016X | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) | Group - Multi-Specialty |
| No | 171400000X | Other Service Providers | Health & Wellness Coach | Group - Multi-Specialty | |
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 364SP0807X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
| No | 364SP0810X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Family | Group - Multi-Specialty |
