| NPI | 1174965370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACIA DANIS Credentialing Specialist 520-591-5394 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: AZ BH4297) |
| Enumeration Date | 2013-07-29 |
| Last Update Date | 2024-07-31 |