# BLACK CANYON THERAPY AND WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003566845
- **Authorized official:** RACHAEL MILES LMFT (OWNER)
- **Authorized official phone:** (585) 339-8822

## Contact information

- **Practice address:** 3061 W CASINO AVE, PHOENIX, AZ 85083-5890
- **Practice address phone:** (585) 339-8822
- **Mailing address:** 3061 W CASINO AVE, PHOENIX, AZ 85083-5890
- **Mailing address phone:** (585) 339-8822

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 03/25/2022
- **Last updated:** 03/25/2022