| NPI | 1134359292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED COGBURN Chief Operations Officer 928-346-0220 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: AZ BH-3247) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ BH-3247) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ BH-3247) | |
| 101YM0800X Counselor, Mental Health (Licence: AZ BH-3247) | |
| 101YP2500X Counselor, Professional (Licence: AZ BH-3247) | |
| 103G00000X Clinical Neuropsychologist (Licence: AZ BH-3247) | |
| 103T00000X Psychologist (Licence: AZ BH-3247) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ BH-3247) | |
| 103TC0700X Psychologist, Clinical (Licence: AZ BH-3247) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AZ BH-3247) | |
| 103TF0000X Psychologist, Family (Licence: AZ BH-3247) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: AZ BH-3247) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: AZ BH-3247) | |
| 104100000X Social Worker (Licence: AZ BH-3247) | |
| 1041C0700X Social Worker, Clinical (Licence: AZ BH-3247) | |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2009-07-23 |