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:CO-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, LIAC
Authorized Official - Phone:480-256-8566
Mailing Address - Street 1:1930 S ALMA SCHOOL RD STE A203
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3066
Mailing Address - Country:US
Mailing Address - Phone:480-256-8566
Mailing Address - Fax:
Practice Address - Street 1:1930 S ALMA SCHOOL RD STE A203
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3066
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:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)