| NPI | 1699262717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MILY GOMEZ Clinician 928-247-6430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: AZ 16637) |
| Enumeration Date | 2018-04-14 |
| Last Update Date | 2018-04-14 |