Provider Demographics
NPI:1437690187
Name:ANASAZI INTEGRATED HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:ANASAZI INTEGRATED HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:T
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:480-228-1400
Mailing Address - Street 1:745 N GILBERT RD
Mailing Address - Street 2:124-313
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3375
Mailing Address - Country:US
Mailing Address - Phone:480-228-1400
Mailing Address - Fax:480-400-1750
Practice Address - Street 1:1855 E SOUTHERN AVE
Practice Address - Street 2:STE 205
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5241
Practice Address - Country:US
Practice Address - Phone:480-228-1400
Practice Address - Fax:480-400-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSLG8091251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health