| NPI | 1942173646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN CARLISLE Manager 480-219-7098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent |
| 364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent | |
| Enumeration Date | 2025-09-29 |
| Last Update Date | 2025-09-29 |