| NPI | 1740931625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EZINNE IROKU CEO 623-218-6691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2023-01-12 |