Provider Demographics
NPI:1720531346
Name:ARIZONA INTEGRATED MOBILE WELLNESS, LLC
Entity Type:Organization
Organization Name:ARIZONA INTEGRATED MOBILE WELLNESS, LLC
Other - Org Name:AIM WELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOWDALL-THOMAE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-906-1227
Mailing Address - Street 1:633 N. 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705
Mailing Address - Country:US
Mailing Address - Phone:520-906-1227
Mailing Address - Fax:
Practice Address - Street 1:8987 E TANQUE VERDE RD STE 309-108
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-9610
Practice Address - Country:US
Practice Address - Phone:520-906-1227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty