Blooming Agave Wellness LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

BLOOMING AGAVE WELLNESS LLC

Practice address

4117 N 17TH St
Phoenix, AZ 85016-5921

Phone

(623) 239-2312

NPI assigned

Aug 23, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joshua Phillips, LPCNPI 1285304584

Title

Therapist/Owner

Phone

(970) 260-8286

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joshua Paul Phillips, LPC

  • Counselor
  • Phoenix, AZ
  • NPI 1285304584
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1053144154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16609 N 34TH PL",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322776",
            "telephone_number": "970-260-8286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4117 N 17TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165921",
            "telephone_number": "623-239-2312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMING AGAVE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-23",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "THERAPIST/OWNER",
        "authorized_official_telephone_number": "970-260-8286",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bloom Home Assisted Living
• Katherine Kramer Bloom, LPC
• Pacific Bloom
• Bloom365
• Jay Bloomfield, P.T.
• Blooming Bellies Doula Services LLC
• Paul R Bloomquist, MD
• Joshua Aaron Bloomstone, MD
• Diana Carolina Blose-Garcia
• Blossom ABA Therapy Az LLC

• Adult Mental Health Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Adult Mental Health Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.