| NPI | 1376601914 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKE WILSON Senior Credentialing Specialist 928-772-4131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ BH-3517) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ BH-2730) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2025-03-05 |