| NPI | 1780203794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ESTIL WALLACE Founder/CEO 602-544-6832 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine |
| Additional Taxonomies | 225XM0800X Occupational Therapist Mental Health |
| 225XP0019X Occupational Therapist Physical Rehabilitation | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2020-04-09 |