| NPI | 1013459593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE LEE PETERSON Billing Coordinator 520-441-4754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-13586) |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2016-11-15 |