# FOURTH WALL WELLNESS LLC

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

## Provider details

- **NPI number:** 1124869581
- **Authorized official:** AURORA THRUSH LPC (MEMBER)
- **Authorized official phone:** (720) 232-7784

## Contact information

- **Practice address:** 6137 E GRANT RD, TUCSON, AZ 85712-5829
- **Practice address phone:** (520) 436-3922
- **Mailing address:** 6137 E GRANT RD, TUCSON, AZ 85712-5829
- **Mailing address phone:** (520) 436-3922

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 06/01/2024
- **Last updated:** 02/24/2025