| NPI | 1386350049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANLEY KIDIAVAYI Provider 602-856-6116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2024-09-11 |