Provider Demographics
NPI:1306594031
Name:BLACKHORSE THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:BLACKHORSE THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLORIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKHORSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-350-1648
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-0080
Mailing Address - Country:US
Mailing Address - Phone:602-350-1648
Mailing Address - Fax:
Practice Address - Street 1:2425 S 121ST DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-7667
Practice Address - Country:US
Practice Address - Phone:602-350-1648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty