Grand Canyon Wellness Center

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

GRAND CANYON WELLNESS CENTER

Practice address

2423 W Dunlap Ave Ste 110
Phoenix, AZ 85021-2830

Phone

(702) 677-7410

NPI assigned

Jun 14, 2021

Organization subpart

No

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

Authorized official

Name

Niecey Bolden

Title

Owner

Phone

(702) 677-7410

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1623628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623628800000",
    "number": "1356919583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2423 W DUNLAP AVE STE 110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850212830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2423 W DUNLAP AVE STE 110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850212830",
            "telephone_number": "702-677-7410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND CANYON WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-14",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A",
        "authorized_official_last_name": "BOLDEN",
        "authorized_official_first_name": "NIECEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-677-7410"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grand Canyon Education, Inc.
• Grand Canyon Home Care Inc.
• Grand Canyon Home Health Care, Inc.
• Grand Canyon Lab LLC
• Grand Canyon University
• Grand Desert Home Health, LLC
• Grand Services and More LLC
• Grand Therapy LTD
• Grande Integrated Wellness Solutions LLC
• Grande Integrated Wellness Solutions LLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.