| NPI | 1912644543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE DECKER Credentialing Manager 480-269-2971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional | |
| 103TC0700X Psychologist Clinical | |
| 1041C0700X Social Worker Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 207Q00000X Family Medicine | |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2022-09-13 |