VIVIFY WELLNESS LLC (NPI# 1366807596) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366807596 |
| Entity Type | Organization |
| Organization Name | VIVIFY WELLNESS LLC |
| Practice Address |
2345 S Alma School Rd Suite 105 Mesa AZ 85210-4012 |
| Mailing Address |
18445 E Pine Valley Dr Queen Creek AZ 85142-3622 |
| Practice Telephone | 4802064753 |
| Mailing Telephone | 4802064753 |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2015-12-14 |
| Authorized Official Name | LAURA FONTAINE (OWNER) |
| Authorized Official Telephone | 4809876529 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
10622 | AZ | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | LICENSE | 10622 | 01 |
| Street Address |
2345 S ALMA SCHOOL RD SUITE 105 |
| City | MESA |
| State | AZ |
| Zip Code | 85210-4012 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023231594 | Teri Virginia Krull | Social Worker | 2345 S Alma School Rd, 110, Mesa, AZ 85210-4011 | 2007-04-11 |
| 1770021180 | Amy Boylan | Counselor | 2345 S Alma School Rd, Suite 105, Mesa, AZ 85210-4012 | 2017-02-06 |
| 1245691948 | Beyond Counseling LLC | Counselor | 2345 S Alma School Rd, Suite 105, Mesa, AZ 85210-4012 | 2016-03-09 |
| 1013375781 | Rosa Ruales | Counselor | 2345 S Alma School Rd, Suite 105, Mesa, AZ 85210-4012 | 2016-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497382501 | Mesa Center for Family Medicine | Internal Medicine | 2034 S Alma School Road, Suite #101, Mesa, AZ 85210 | 2020-03-26 |
| 1780177121 | Jessica Cannata | Speech-Language Pathologist | 2150 S Country Club Rd, Suite 20, Mesa, AZ 85210 | 2018-06-11 |
| 1831680305 | Alexandra Katherine Ebong | Nurse Practitioner | 1950 S. Country Club Drive, Ste 102, Mesa, AZ 85210 | 2018-05-21 |
| 1548762719 | Russell D. Meldrum, M.d. Pllc | Orthopaedic Surgery | 855 W. Southern Ave., #1114, Mesa, AZ 85210 | 2018-03-05 |
| 1023510435 | Denise M Bruno-krupp | Counselor | 1830 S. Alma School Rd. Suite 101, Mesa, AZ 85210 | 2018-03-01 |
| 1609374529 | Gene R Lullo | Social Worker | 1830 S Alma School Rd Suite 101, Mesa, AZ 85210 | 2018-01-25 |
| 1295264000 | Ashley P Smith | Naturopath | 601 S Alma School Rd, Apt 101, Mesa, AZ 85210 | 2017-06-06 |
| 1386184059 | Brittany Johnson | Counselor | 1745 S Alma School Rd Ste 230, Mesa, AZ 85210 | 2017-03-01 |
| 1487190880 | Mesa Valley Modern Dentistry, LLP | Dentist | 1712 S, Country Club Drive, Ste 104, Mesa, AZ 85210 | 2017-01-10 |
| 1821544529 | Sandra Coren | Licensed Practical Nurse | 32 S Mcdonald, Tlc, Mesa, AZ 85210 | 2016-09-01 |
| Find all providers in zip 85210 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932725504 | Cheryl Hawley | Counselor | 2727 S Sawyer Cir, Mesa, AZ 85209-6257 | 2020-06-19 |
| 1578192357 | Katherine Desio-scott | Counselor | 9860 E Escondido Ave, Mesa, AZ 85208-3129 | 2020-04-03 |
| 1821639642 | Arizona Intergrated Tele Psychiatry and Tele Medicine Services LLC | Counselor | 2735 E Main St Ste 3, Mesa, AZ 85213-9269 | 2019-10-02 |
| 1881253961 | Amy Massey | Counselor | 522 W Edgewood Ave, Mesa, AZ 85210-3509 | 2019-06-11 |
| 1538630009 | Community Medical Services Arizona-private, LLC | Counselor | 2940 E Main St, Mesa, AZ 85213-9305 | 2018-12-10 |
| 1982128187 | Michael Anthony Jones | Counselor | 1107 North Gilbert Rd, Mesa, AZ 85204 | 2017-07-29 |
| 1780137729 | Maxine Mandell | Counselor | 3130 E Caballero St, Mesa, AZ 85213-7902 | 2016-07-26 |
| 1457726036 | Laura Fontaine | Counselor | 2345 S Alma School Rd Ste 105, Mesa, AZ 85210-4013 | 2015-12-07 |
| 1144625765 | Elevate Arizona | Counselor | 3208 N Ladera Cir, Mesa, AZ 85207-0810 | 2014-10-24 |
| 1013311356 | Chad H Close | Counselor | 650 W. Southern Ave., Mesa, AZ 85210 | 2014-10-15 |
| Find all providers in MESA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.