| Mental Health Wellness Boutique | |
|
10210 W Happy Valley Pkwy Ste 145 Peoria AZ 85383-2881 | |
| (888) 906-8301 | |
| (623) 404-6602 |
| Full Name | Mental Health Wellness Boutique |
|---|---|
| Speciality | Clinic/Center |
| Location | 10210 W Happy Valley Pkwy Ste 145, Peoria, Arizona |
| Authorized Official Name and Position | Irina Ashamalla (CEO) |
| Authorized Official Contact | 8889068301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mental Health Wellness Boutique 10210 W Happy Valley Pkwy Ste 145 Peoria AZ 85383-2881 Ph: (888) 906-8301 | Mental Health Wellness Boutique 10210 W Happy Valley Pkwy Ste 145 Peoria AZ 85383-2881 Ph: (888) 906-8301 |
| NPI Number | 1972266757 |
|---|---|
| Provider Enumeration Date | 10/18/2021 |
| Last Update Date | 03/23/2022 |
| Certification Date | 03/23/2022 |
| Medicare PECOS PAC ID | 6709272479 |
|---|---|
| Medicare Enrollment ID | O20220405002346 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972266757 | NPI | - | NPPES |
| 1205365772 | Other | AZ | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Irina Ashamalla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205365772 PECOS PAC ID: 5698032449 Enrollment ID: I20171201002914 |
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