| NPI | 1093434862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT P EKSTROM Member 480-208-3900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2022-08-25 |