Provider Demographics
NPI:1871118919
Name:FIT MIND WELLNESS, LLC
Entity type:Organization
Organization Name:FIT MIND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES-GABALDON
Authorized Official - Suffix:
Authorized Official - Credentials:DBH, LPC
Authorized Official - Phone:480-292-3219
Mailing Address - Street 1:34975 N NORTH VALLEY PKWY STE 152
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-4032
Mailing Address - Country:US
Mailing Address - Phone:480-525-7091
Mailing Address - Fax:
Practice Address - Street 1:34975 N NORTH VALLEY PKWY STE 152
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-4032
Practice Address - Country:US
Practice Address - Phone:480-525-7091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty