| NPI | 1740641612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL JOSEPH NICHOLS Clinical Director 480-284-7440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: AZ BH4837) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ BH4837) |
| 101YM0800X Counselor, Mental Health (Licence: AZ BH4837) | |
| 1041C0700X Social Worker, Clinical (Licence: AZ BH4837) | |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: AZ BH4837) | |
| 261QM1300X Clinic/Center, Multi-Specialty (Licence: AZ BH4837) | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH4837) | |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ BH4837) | |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2020-01-23 |