Organization
BLOOMING AGAVE WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA PHILLIPS LPC (THERAPIST/OWNER)
(970) 260-8286
Entity
Organization
Contact information
Practice address
4117 N 17TH ST, PHOENIX, AZ 85016-5921
(623) 239-2312
Mailing address
16609 N 34TH PL, PHOENIX, AZ 85032-2776
(970) 260-8286
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
08/23/2024
Last updated
08/23/2024
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