| NPI | 1649753286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAM LAMPLE Owner 623-523-9107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2021-04-09 |