| NPI | 1609475144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE GORDON Owner 480-295-6181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2020-10-24 |
| Last Update Date | 2020-10-24 |