| NPI | 1750163895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONGA THERESE BRYANT Owner/Authorized Agent 480-420-9603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2023-10-13 |
| Last Update Date | 2023-10-26 |