Obsidian Health and Wellness LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

OBSIDIAN HEALTH AND WELLNESS LLC

Practice address

13321 W Indian School Rd Ste A107
Litchfield Park, AZ 85340-4339

Phone

(623) 293-2232

Fax

(623) 321-9524

NPI assigned

Nov 25, 2019

Organization subpart

No

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

Authorized official

Name

Deborah Grace

Title

Consultant

Phone

(602) 696-3556

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Jennifer L Flack, LCSW

  • Clinical Social Worker
  • Phoenix, AZ
  • NPI 1760920789
  NPD

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

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574640000000",
    "number": "1417593575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13321 W INDIAN SCHOOL RD STE A107",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "853404339",
            "telephone_number": "623-293-2232",
            "fax_number": "623-321-9524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13321 W INDIAN SCHOOL RD STE A107",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "853404339",
            "telephone_number": "623-293-2232",
            "fax_number": "623-321-9524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBSIDIAN HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-25",
        "last_updated": "2019-11-25",
        "status": "A",
        "authorized_official_last_name": "GRACE",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "CONSULTANT",
        "authorized_official_telephone_number": "602-696-3556"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "435346",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NR Chiropractic LLC
• Kimberly Nudi, CCC-SLP
• Nufoundation Youth Development Mentors and Life Coach Services
• Nufoundation Youth Services LLC.
• Kristin Angeli Oarde, FNP-C
• Obsidian Health and Wellness LLC
• Norma Ochoa, RBT
• Rebecca A Odede, PMHNP
• Patrick Olivas, COTA/L
• Saraih A Olmos, RBT

• Adult Mental Health Clinic/Center in Litchfield Park, AZ
• Providers in Litchfield Park, 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 Nov 25, 2019; 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.