| NPI | 1154501682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS ALAN BERGSTROM Psychologist 928-445-3835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ 1142) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2007-11-13 |