| NPI | 1316440241 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE PETERSON Billing Coordinator 520-441-4754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ LCSW15769) |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2018-03-16 |