Provider Demographics
NPI:1568934107
Name:EARTHWALK WELLNESS GROUP, LLC
Entity Type:Organization
Organization Name:EARTHWALK WELLNESS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KYRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-349-1031
Mailing Address - Street 1:7373 EAST DOUBLETREE RANCH
Mailing Address - Street 2:SUITE 165
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258
Mailing Address - Country:US
Mailing Address - Phone:480-664-7478
Mailing Address - Fax:602-297-6890
Practice Address - Street 1:14050 NORTH 83RD AVENUE
Practice Address - Street 2:SUITE 290
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:480-349-1031
Practice Address - Fax:623-321-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty