| NPI | 1356030951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHANNAH BLAKE Owner/Provider 520-654-5502 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2025-04-27 |