| NPI | 1114221645 | 
|---|---|
| Doing Business As | MARY'S MISSION OUTPATIENT CLINIC | 
| Entity Type | Organization | 
| Authorized Contact | WILLIAM LACEY CEO 480-844-0022  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ BH-3732)  | 
| Enumeration Date | 2010-12-23 | 
| Last Update Date | 2010-12-23 |