| NPI | 1902528292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI ERICKSON Administrator 602-881-1062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2022-09-14 |
| Last Update Date | 2022-09-30 |