| NPI | 1023511672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY MICHAEL TROUTMAN Owner/Clinical Social Worker 480-465-9841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ LCSW-13890) |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: AZ LCSW-13890) |
| 302F00000X Exclusive Provider Organization (Licence: AZ LCSW-13890) | |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2018-03-09 |