| NPI | 1386380996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH7438) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: AZ BH7438) |
| 101YP2500X Counselor Professional (Licence: AZ BH7438) | |
| 1041C0700X Social Worker Clinical (Licence: AZ BH7438) | |
| 261QM0850X Clinic/Center Adult Mental Health (Licence: BH7438) | |
| 323P00000X Psychiatric Residential Treatment Facility (Licence: AZ BH7438) | |
| Enumeration Date | 2022-05-06 |
| Last Update Date | 2024-06-19 |