| NPI | 1114259397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID LESLIE LEWIS Therapist 520-620-6615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: AZ LPC11296; LISAC1012) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LPC11296; LISAC1012) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2010-02-12 |