| NPI | 1649897414 |
|---|---|
| Former Legal Business Name | DESERT BOLT BEHAVIORAL LLC |
| Entity Type | Organization |
| Authorized Contact | VALERY A NKENDONG CEO 480-527-0042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-06-28 |
| Last Update Date | 2021-07-05 |