Organization
KETAMINE WELLNESS CENTERS ARIZONA LLC
Active
Other names
Ketamine Wellness Centers
Organization subpart
No
Provider details
NPI number
Authorized official
ANITA JERGER (EXECUTIVE ASSISTANT)
(855) 538-9355
Entity
Organization
Contact information
Practice address
113 W HOOVER AVE STE 101, MESA, AZ 85210-5214
(855) 538-9355
(844) 538-9355
Mailing address
113 W HOOVER AVE STE 101, MESA, AZ 85210-5214
(855) 538-9355
(844) 538-9355
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
06/26/2015
Last updated
08/21/2020
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