Mental Health Wellness Boutique

Primary specialty

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

Legal business name

MENTAL HEALTH WELLNESS BOUTIQUE

Practice address

18001 N 79TH Ave Ste B48
Glendale, AZ 85308-8393

Phone

(888) 906-8301

Fax

(623) 404-6602

NPI assigned

Oct 18, 2021

Organization subpart

No

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

Authorized official

Name

Irina Ashamalla, PMHNP-BC, FNP-CNPI 1205365772

Title

Ceo

Phone

(888) 906-8301

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24909/brand/1/csg/1/fhir/r4

Practitioners 1

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

• Irina Vladimirovna Ashamalla, MSN, FNP-C, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Glendale, AZ
  • NPI 1205365772
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1634515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723334400000",
    "number": "1972266757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18001 N 79TH AVE STE B48",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088393",
            "telephone_number": "888-906-8301",
            "fax_number": "623-404-6602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18001 N 79TH AVE STE B48",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088393",
            "telephone_number": "888-906-8301",
            "fax_number": "623-404-6602"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10210 W Happy Valley Pkwy Ste 145",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "AZ",
            "postal_code": "853832881",
            "country_code": "US",
            "telephone_number": "888-906-8301",
            "fax_number": "623-404-6602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MENTAL HEALTH WELLNESS BOUTIQUE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-18",
        "last_updated": "2024-08-11",
        "certification_date": "2024-08-11",
        "status": "A",
        "authorized_official_last_name": "ASHAMALLA",
        "authorized_official_first_name": "IRINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "888-906-8301",
        "authorized_official_credential": "PMHNP-BC, FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1205365772",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "AthenaHealth",
            "affiliation": "N",
            "address_1": "10210 W Happy Valley Pkwy Ste 145",
            "city": "Peoria",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "853832881",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "AthenaHealth",
            "affiliation": "N",
            "address_1": "18001 N 79th Ave Ste B48",
            "city": "Glendale",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "853088393",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Paola Mendoza, PA-C
• Phaktra Meng
• Tzuyu Meng, D.D.S.
• Christopher James Menghini, D.D.S.
• Daisy Menjivar
• Alexander Ian Meraz, MD
• Brenda Alina Mercado-Tarango, DPT
• Anthony Mercado
• Desiree Meredith
• Stacy-Ann Marie Meredith, LMSW

• Mental Health Clinic/Center (Including Community Mental Health Center) in Glendale, AZ
• Providers in Glendale, 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 Aug 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.