| NPI | 1417428483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAURICE LAKES Credentialing Supervisor 602-342-7179 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2024-02-23 |