| NPI | 1639996390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN CARLISLE Administrator 623-693-2198 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2024-09-24 |