| NPI | 1093452203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN MAYBERRY Owner 480-203-3519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251B00000X Case Management | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2023-03-30 |