| NPI | 1669918439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY LYN POE Contracts Administrator 520-570-1460 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X (Licence: NV NV20001430165) |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2021-08-12 |