| NPI | 1174387088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA JUN COO 623-298-5044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0801X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-03-27 |