| NPI | 1114789666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES JACKSON Cco 480-520-7921 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TC1900X Psychologist, Counseling | |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) | |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 207RA0401X Internal Medicine, Addiction Medicine | |
| 2083A0300X Preventive Medicine, Addiction Medicine | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2024-08-30 |