NPIMap

Organization Active NPI

San Carlos Apache Wellness Center

  • Professional Counselor
  • San Carlos, AZ
National Provider Identifier
1821218801
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
SAN CARLOS APACHE WELLNESS CENTER
Practice address
5 San Carlos Boulevard
San Carlos, AZ 85550
Phone
(928) 475-4875
Fax
(928) 475-4880
NPI assigned
May 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Ahmad Reza Djangi, PSY.D.
Title
Director
Phone
(928) 475-4875

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X IL Primary

Addresses

Primary practice location

5 San Carlos Boulevard
San Carlos, AZ 85550

Mailing address

5 San Carlos Boulevard
San Carlos, AZ 85550
Phone (928) 475-4875

Other names 1

  • Wellness Center Other name

National Provider Directory

National Provider Directory
Tax ID family
San Carlos Apache Tribe7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821218801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 SAN CARLOS BOULEVARD",
            "city": "SAN CARLOS",
            "state": "AZ",
            "postal_code": "85550",
            "telephone_number": "928-475-4875",
            "fax_number": "928-475-4880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 SAN CARLOS BOULEVARD",
            "city": "SAN CARLOS",
            "state": "AZ",
            "postal_code": "85550",
            "telephone_number": "928-475-4875",
            "fax_number": "928-475-4880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN CARLOS APACHE WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DJANGI",
        "authorized_official_first_name": "AHMAD",
        "authorized_official_middle_name": "REZA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "928-475-4875",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Carlos, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.