| NPI | 1467639302 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS WHITE Statutory Agent 602-420-3406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC12028) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW10380) |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2008-01-23 |