NPIMap

Organization Active NPI

Az Pure Wellness, Licensed Clinical Social Worker, P.C.

  • Mental Health Counselor
  • Peoria, AZ
National Provider Identifier
1952032328
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
AZ PURE WELLNESS, LICENSED CLINICAL SOCIAL WORKER, P.C.
Practice address
7865 W Bell Rd # 1056
Peoria, AZ 85382-3803
Phone
(602) 825-3925
NPI assigned
Jun 17, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

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

Authorized official

Name
Vivian Fajardo, LCSW
Title
Clinician Manager
Phone
(602) 825-3925

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

7865 W Bell Rd # 1056
Peoria, AZ 85382-3803

Mailing address

7865 W Bell Rd # 1056
Peoria, AZ 85382-3803
Phone (602) 825-3925

Other names 2

  • AZ Pure Wellness Doing business as
  • AZ Pure Wellness LLC Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1655424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742169600000",
    "number": "1952032328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7865 W BELL RD # 1056",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853823803",
            "telephone_number": "602-825-3925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7865 W BELL RD # 1056",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853823803",
            "telephone_number": "602-825-3925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZ PURE WELLNESS, LICENSED CLINICAL SOCIAL WORKER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-17",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A",
        "authorized_official_last_name": "FAJARDO",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_title_or_position": "CLINICIAN MANAGER",
        "authorized_official_telephone_number": "602-825-3925",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AZ Pure Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AZ Pure Wellness LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; 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.