| NPI | 1245865096 |
|---|---|
| Doing Business As | CLEANSLATE CENTERS- WEST THOMAS PHOENIX, AZ |
| Entity Type | Organization |
| Authorized Contact | JESSICA AMICK AO 727-798-8160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2023-03-23 |