| NPI | 1619742244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEBASTIAN DEE RANDOLPH Clinical Mental Health Counselor 602-736-7383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2023-11-27 |