Fourth Wall Wellness LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

FOURTH WALL WELLNESS LLC

Practice address

6137 E Grant Rd
Tucson, AZ 85712-5829

Phone

(520) 436-3922

NPI assigned

Jun 1, 2024

Organization subpart

No

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

Authorized official

Name

Aurora Thrush, LPCNPI 1083923288

Title

Member

Phone

(720) 232-7784

Specialties & licenses 2

Addresses

Locations

Practitioners 4

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

• Aurora Thrush

  • Mental Health Counselor
  • Tucson, AZ
  • NPI 1083923288
  NPD Authorized official
• Sara Moss

  • Psychiatric/Mental Health Nurse Practitioner
  • Tucson, AZ
  • NPI 1376321901
  NPD
• River Tammetta

  • Psychiatric/Mental Health Nurse Practitioner
  • Tucson, AZ
  • NPI 1689387631
  NPD
• Ada Gingyen Lam

  • Mental Health Counselor
  • Tucson, AZ
  • NPI 1366394678
  NPD (past)

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

{
    "created_epoch": "1717200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740355200000",
    "number": "1124869581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6137 E GRANT RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857125829",
            "telephone_number": "520-436-3922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6137 E GRANT RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857125829",
            "telephone_number": "520-436-3922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOURTH WALL WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-01",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A",
        "authorized_official_last_name": "THRUSH",
        "authorized_official_first_name": "AURORA",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "720-232-7784",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Elizabeth Foulk, MS CCC SLP
• Founders Healthcare, LLC (Preferred Homecare)
• Amaria Fountain
• Francis Donald Fountain, LPC
• Andre Chester Fournier, D.C.
• Haley Foushee
• Nina Foushee
• Jennifer A Fout, LPC
• Marie Fouts
• Michele Foutz, OTR/L

• Psychiatric/Mental Health Nurse Practitioner in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; 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.