| NPI | 1932988763 |
|---|---|
| Former Legal Business Name | BACK TO LIFE MENTAL HEALTH PLLC |
| Entity Type | Organization |
| Authorized Contact | LOGAN ELI CARTON Manager/Owner 480-353-7133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-09-21 |
| Last Update Date | 2023-11-17 |