| NPI | 1326857202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IGOR GADAEV Credentialing Manager 623-666-1904 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2025-01-06 |
| Last Update Date | 2025-08-19 |