| NPI | 1316693419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN KODYSZ Chief Operations Officer 602-492-2121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-02-28 |
| Last Update Date | 2023-10-04 |