| NPI | 1184362196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL OLSEN Owner 623-440-4358 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-05-20 |
| Last Update Date | 2023-02-23 |