| NPI | 1982544847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE NAU Credentialing 689-686-4665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2026-03-31 |
| Last Update Date | 2026-07-20 |