Vivify Wellness LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

10622 Issued in AZ

Legal business name

VIVIFY WELLNESS LLC

Practice address

2345 S Alma School Rd
Suite 105
Mesa, AZ 85210-4012

Phone

(480) 206-4753

NPI assigned

Dec 14, 2015

Last updated

Dec 14, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Laura FontaineNPI 1457726036

Title

Owner

Phone

(480) 987-6529

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Laura Fontaine, MS, EDS, LISAC, LPC

  • Professional Counselor
  • Mesa, AZ
  • NPI 1457726036

  Addiction (Substance Use Disorder)

  NPD (past) Authorized official
• Michael Dean, MAS-MFT, LMFT

  • Marriage & Family Therapist
  • Phoenix, AZ
  • NPI 1205480357
  NPD (past)

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

{
    "created_epoch": "1450051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450051200000",
    "number": "1366807596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18445 E PINE VALLEY DR",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851423622",
            "telephone_number": "480-206-4753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2345 S ALMA SCHOOL RD",
            "address_2": "SUITE 105",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852104012",
            "telephone_number": "480-206-4753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVIFY WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-14",
        "last_updated": "2015-12-14",
        "status": "A",
        "authorized_official_last_name": "FONTAINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-987-6529"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "10622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "10622",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Addiction (Substance Use Disorder) Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2015; 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.