Provider Demographics
NPI:1932858081
Name:ARIZONA HOLISTIC HEALING AGENCY LLC
Entity Type:Organization
Organization Name:ARIZONA HOLISTIC HEALING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HALLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LISAC
Authorized Official - Phone:480-360-2172
Mailing Address - Street 1:3289 E ARIS DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4235
Mailing Address - Country:US
Mailing Address - Phone:480-360-2172
Mailing Address - Fax:
Practice Address - Street 1:1930 S ALMA SCHOOL RD STE B212
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2104
Practice Address - Country:US
Practice Address - Phone:480-360-2172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health