Provider Demographics
NPI:1073278495
Name:BLISSFUL MIND BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:BLISSFUL MIND BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:
Authorized Official - Last Name:INIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-226-0300
Mailing Address - Street 1:7330 N 16TH ST STE A110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-8216
Mailing Address - Country:US
Mailing Address - Phone:602-715-3432
Mailing Address - Fax:
Practice Address - Street 1:7330 N 16TH ST STE A110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-8216
Practice Address - Country:US
Practice Address - Phone:602-715-3432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health