| NPI | 1194003350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DD SANDE Credentialing Specialist 520-682-4111 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: AZ BH3894) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2011-10-18 |