| NPI | 1558336818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE LUSK Managing Director 928-774-7997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 3232) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TS0200X Psychologist, School | |
| 261QR1300X Clinic/Center, Rural Health | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2020-07-06 |