| NPI | 1316458169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON MOORE Credentials 602-400-0800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ lpc-13258) |
| Enumeration Date | 2017-10-19 |
| Last Update Date | 2017-10-19 |