1. Home
  2. Directory
  3. Arizona
  4. Phoenix
  5. Clinic Center
  6. NPI Profile

BLOOMING AGAVE WELLNESS LLC
NPI 1053144154
Clinic/Center - Adult Mental Health in Phoenix, AZ

Active since August 23, 2024
4117 N 17TH ST, PHOENIX, AZ 85016(623) 239-2312 Get Directions Write a Review

NPPES record last updated: August 23, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Blooming Agave Wellness Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLOOMING AGAVE WELLNESS LLC (NPI 1053144154) is a healthcare organization registered as an adult mental health in Phoenix, Arizona and active in the NPI registry since August 2024. The organization lists Joshua Phillips, Therapist/owner, as its authorized official.

NPPES Registry Identity

NPI1053144154
Entity TypeOrganization
Primary Taxonomy261QM0850X
Legal Business NameBLOOMING AGAVE WELLNESS LLC
Location Address4117 N 17TH STPhoenix, AZ 85016-5921
Mailing Address16609 N 34th PlPhoenix, AZ 85032-2776 · (970) 260-8286
Phone(623) 239-2312
Organization SubpartNo
Authorized OfficialJoshua PhillipsTherapist/owner · (970) 260-8286
Enumeration DateAugust 23, 2024
NPPES CertifiedAugust 23, 2024
✔ NPI 1053144154 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Adult Mental HealthAmbulatory Health Care Facilities
Taxonomy Code261QM0850X
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
4117 N 17TH ST, Phoenix, AZ 85016
Open in Google Maps ↗

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOSHUA PAUL PHILLIPS LPC
Counselor
4117 N 17TH ST
PHOENIX, AZ 85016
Maricopa County (623) 239-2312
MR. KEVIN C FLYNN LCSW
Community/Behavioral Health
4117 N 17TH ST
PHOENIX, AZ 85016
Maricopa County (602) 258-6797
HANNAH GRACE STONEHILL MC, LPC
Counselor (Professional)
4117 N 17TH ST
PHOENIX, AZ 85016
Maricopa County (480) 269-1041
BRIAN KUMMET PA-C
Physician Assistant
4117 N 17TH ST
PHOENIX, AZ 85016
Maricopa County (480) 341-5174
EMMA CENTER INC
Early Intervention Provider Agency
4117 N 17TH ST
PHOENIX, AZ 85016
Maricopa County (602) 266-0887

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blooming Agave Wellness LLC's NPI number?

The NPI number for Blooming Agave Wellness LLC is 1053144154. It was assigned to this organization in the NPPES registry on August 23, 2024.

Where is Blooming Agave Wellness LLC located?

Blooming Agave Wellness LLC is located at 4117 N 17th St, Phoenix, AZ 85016. The listed phone number is (623) 239-2312.

What is Blooming Agave Wellness LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Adult Mental Health, with taxonomy code 261QM0850X.

When was this NPI record last updated?

The NPPES record for Blooming Agave Wellness LLC was last updated on August 23, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.