| NPI | 1669983433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER E BAGBY Owner 480-834-3507 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 6520) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 6193) |
| Enumeration Date | 2017-10-19 |
| Last Update Date | 2023-03-23 |