Organization
OBSIDIAN HEALTH AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH GRACE (CONSULTANT)
(602) 696-3556
Entity
Organization
Contact information
Practice address
13321 W INDIAN SCHOOL RD STE A107, LITCHFIELD PARK, AZ 85340-4339
(623) 293-2232
(623) 321-9524
Mailing address
13321 W INDIAN SCHOOL RD STE A107, LITCHFIELD PARK, AZ 85340-4339
(623) 293-2232
(623) 321-9524
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
435346
—
AZ
Enumeration date
11/25/2019
Last updated
11/25/2019
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