| NPI | 1194232512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA KINNAMAN Clinical Director 480-653-8434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ CSLG8879) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ OTC8779) |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2018-08-09 |