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Organization
MENTAL HEALTH WELLNESS BOUTIQUE
Active
Organization
MENTAL HEALTH WELLNESS BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRINA ASHAMALLA PMHNP-BC, FNP-C (CEO)
(888) 906-8301
Entity
Organization
Contact information
Practice address
18001 N 79TH AVE STE B48, GLENDALE, AZ 85308-8393
(888) 906-8301
(623) 404-6602
Mailing address
18001 N 79TH AVE STE B48, GLENDALE, AZ 85308-8393
(888) 906-8301
(623) 404-6602
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1205365772
INDIVIDUAL NPI
AZ
Enumeration date
10/18/2021
Last updated
08/11/2024
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