| NPI | 1922545755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA ANIFOWOSE Credentialing Specialist 602-416-7616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM2800X Clinic/Center Methadone |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2020-04-07 |