| NPI | 1568107795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FUNSO OGUNLA Owner 602-384-8820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2023-03-05 |