| NPI | 1366941361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISE BALLOU Chief Executive Officer 623-225-6220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 45661) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 4900) |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2020-11-16 |