| NPI | 1003982133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER HOUDE Credentialing 928-642-5583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ BH-4062) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: AZ BH 1958) |
| 251S00000X Community/Behavioral Health (Licence: AZ BH-373) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2025-12-10 |