| NPI | 1043043698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AZEL JACKSON CEO 602-367-9663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2024-08-20 |