| NPI | 1053206425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISSA ASCH CAILLET Coach And Counselor 520-647-4407 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2025-06-09 |
| Last Update Date | 2025-07-16 |