| NPI | 1194137315 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE RAMON BUCIO Clinical Supervisor 928-376-0026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: AZ LPC-14075) |
| Additional Taxonomies | 251B00000X Case Management (Licence: AZ LPC-14075) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2014-05-22 |