| NPI | 1770201113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALTHEIN NICHOLSON Provider 623-693-4826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2025-01-14 |