| NPI | 1538049374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID T JOHNSON Program Administrator 623-887-2678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2025-09-03 |
| Last Update Date | 2025-10-06 |