Provider Demographics
NPI:1629697644
Name:MAITRI WELLNESS, PLLC
Entity Type:Organization
Organization Name:MAITRI WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PROEBSTING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-262-0787
Mailing Address - Street 1:2450 E AVENIDA DE POSADA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-3057
Mailing Address - Country:US
Mailing Address - Phone:520-262-0787
Mailing Address - Fax:520-244-1681
Practice Address - Street 1:1431 W MAGEE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-2116
Practice Address - Country:US
Practice Address - Phone:520-262-0787
Practice Address - Fax:520-244-1681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty