| NPI | 1235634429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE PETERSON Billing Coordinator 520-441-4754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: AZ LCSW-12434) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2018-04-20 |