| NPI | 1851969117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA LOU SHANNON-JOSEPH Office Manager 928-499-8405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2021-07-19 |