| NPI | 1932768975 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD FEDRICK Owner 602-320-8368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2019-06-12 |