Provider Demographics
NPI:1578821591
Name:ARIZONA FAMILY THERAPY & WELLNESS CENTER INC.
Entity Type:Organization
Organization Name:ARIZONA FAMILY THERAPY & WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMFT
Authorized Official - Phone:480-254-6395
Mailing Address - Street 1:2525 W GREENWAY RD
Mailing Address - Street 2:STE 330
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-4226
Mailing Address - Country:US
Mailing Address - Phone:480-254-6395
Mailing Address - Fax:623-209-8978
Practice Address - Street 1:2525 W GREENWAY RD
Practice Address - Street 2:STE 330
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-4226
Practice Address - Country:US
Practice Address - Phone:480-254-6395
Practice Address - Fax:623-209-8978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-10281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty