| NPI | 1053997536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAURICE LAKES Credentialing Manager 602-636-3085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2024-01-04 |