| NPI | 1801639646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN CARLISLE Administrator 623-693-2198 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2024-08-02 |