Organization
KETAMINE WELLNESS CENTERS ARIZONA LLC
Active
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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