| NPI | 1841733763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHAN J POPE Owner 928-814-4095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2016-11-25 |
| Last Update Date | 2016-11-25 |