Organization
GRAND CANYON WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIECEY BOLDEN (OWNER)
(702) 677-7410
Entity
Organization
Contact information
Practice address
2423 W DUNLAP AVE STE 110, PHOENIX, AZ 85021-2830
(702) 677-7410
Mailing address
2423 W DUNLAP AVE STE 110, PHOENIX, AZ 85021-2830
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
06/14/2021
Last updated
06/14/2021
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