NPIMap

Organization Active NPI

Free Life Wellness Center LLC

  • Community/Behavioral Health Agency
  • Mesa, AZ
National Provider Identifier
1316539687
Registry record updated Oct 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
FREE LIFE WELLNESS CENTER LLC
Practice address
1731 W Baseline Rd Ste 113
Mesa, AZ 85202-5782
Phone
(480) 687-1773
Fax
(480) 687-2986
NPI assigned
Feb 9, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2023

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

Authorized official

Name
Mrs. Courtney Starr GoochNPI 1922745884
Title
Ceo
Phone
(480) 687-1773

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1731 W Baseline Rd Ste 113
Mesa, AZ 85202-5782

Mailing address

1731 W Baseline Rd Ste 113
Mesa, AZ 85202-5782
Phone (480) 687-1773

Other identifiers 1

IdentifierTypeStateIssuer
100618MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220628002341 AZ Part B Supplier - Clinic/Group Practice 2961881529 Receives reassigned benefits from 1 practitioner
Practice locations: Mesa, AZ

National Provider Directory

National Provider Directory

Locations

1731 W Baseline Rd
Ste 113
Mesa, AZ 85202
Phone (480) 687-1773

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1316539687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1731 W BASELINE RD STE 113",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852025782",
            "telephone_number": "480-687-1773",
            "fax_number": "480-687-2986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1731 W BASELINE RD STE 113",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852025782",
            "telephone_number": "480-687-1773",
            "fax_number": "480-687-2986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREE LIFE WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-09",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-03",
        "status": "A",
        "authorized_official_last_name": "GOOCH",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_middle_name": "STARR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-687-1773",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100618",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.