Provider Demographics
NPI:1386170033
Name:DE NOVO WELLNESS CENTER
Entity type:Organization
Organization Name:DE NOVO WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SOMAYEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUNK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:520-400-4349
Mailing Address - Street 1:7400 N ORACLE RD
Mailing Address - Street 2:SUITE 172
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7400 N ORACLE RD
Practice Address - Street 2:SUITE 172
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6331
Practice Address - Country:US
Practice Address - Phone:520-400-4349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 14085101Y00000X
AZLPC 13260101Y00000X
AZLPC 15271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty