| NPI | 1700132131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY JASON BUCK Member 480-510-8502 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ LPC-13746) |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2012-08-03 |