| NPI | 1851828651 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN M RODRIGUES Owner / Director 602-750-2215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ LPC-13098) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |