| NPI | 1760158554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ULONDA OLD COYOTE Member 602-565-4014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 251S00000X | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2021-08-20 |
| Last Update Date | 2021-08-20 |