| NPI | 1386353621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESTINY N WALLIN Owner 602-317-1006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2024-02-26 |