| NPI | 1689212508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE HOSPODKA Billing/Credentialing 928-537-2951 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2019-12-11 |