Organization
BLOOMING DESERT PRICKLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARYSSA IKEHARA (OWNER)
(775) 287-9463
Entity
Organization
Contact information
Practice address
909 W GROVE PKWY APT 2029, TEMPE, AZ 85283-8422
(775) 287-9463
Mailing address
909 W GROVE PKWY APT 2029, TEMPE, AZ 85283-8422
(775) 287-9463
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
—
000000000
NONE
—
Enumeration date
03/30/2022
Last updated
03/30/2022
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