| NPI | 1952487019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORINNE BAILEY Credentialing Specialist 928-634-2236 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ BH-2174) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2024-07-29 |