| NPI | 1104910868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE NAU Credenitaling Specialist 689-686-4665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 284300000X Special Hospital | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2026-07-21 |