Organization
TAILORED PSYCHIATRIC WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONIA WALLACE (AUTHORIZED OFFICIAL/OWNER)
(708) 829-1520
Entity
Organization
Contact information
Practice address
6751 N SUNSET BLVD STE 320, GLENDALE, AZ 85305-3155
(708) 829-1520
Mailing address
2956 CHATTERING LN, SOUTHAVEN, MS 38672-6108
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
02/07/2024
Last updated
02/29/2024
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