| NPI | 1366112609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYCE BELLUE Part Owner 623-505-8198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2021-09-17 |