| NPI | 1194609677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN ROUSSEAU Billing 520-733-2250 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2025-08-05 |
| Last Update Date | 2025-08-05 |