Organization
FREE LIFE WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. COURTNEY STARR GOOCH (CEO)
(480) 687-1773
Entity
Organization
Contact information
Practice address
1731 W BASELINE RD STE 113, MESA, AZ 85202-5782
(480) 687-1773
(480) 687-2986
Mailing address
1731 W BASELINE RD STE 113, MESA, AZ 85202-5782
(480) 687-1773
(480) 687-2986
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100618
—
AZ
Enumeration date
02/09/2021
Last updated
10/17/2023
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