| NPI | 1528565595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE PETERSON Billing Coordinator 520-441-4754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LCSW16958) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2020-02-21 |