Provider Demographics
NPI:1659026946
Name:WHOLE SELF HEALING OF ARIZONA, LLC
Entity Type:Organization
Organization Name:WHOLE SELF HEALING OF ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:520-261-2328
Mailing Address - Street 1:2806 N ALVERNON WAY STE 500
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1567
Mailing Address - Country:US
Mailing Address - Phone:520-261-2328
Mailing Address - Fax:
Practice Address - Street 1:2806 N ALVERNON WAY STE 500
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1567
Practice Address - Country:US
Practice Address - Phone:520-261-2328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty