Provider Demographics
NPI:1356077309
Name:ADVANCED WELLNESS BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ADVANCED WELLNESS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IYONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:POAGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-423-6322
Mailing Address - Street 1:3707 E SOUTHERN AVE STE 2015
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6213
Mailing Address - Country:US
Mailing Address - Phone:480-331-9805
Mailing Address - Fax:
Practice Address - Street 1:3707 E SOUTHERN AVE STE 2015
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6213
Practice Address - Country:US
Practice Address - Phone:480-331-9805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health