| NPI | 1023718947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN MATTHEW BANTEL Clinical Psychologist 480-992-4996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2023-09-29 |