| NPI | 1184315640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID WILLIAM LEICKEN Owner/Manager 602-910-4050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2023-05-16 |