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4801 S Lakeshore Dr Ste 102 Tempe AZ 85282-7156 | |
| (480) 570-5577 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4801 S Lakeshore Dr Ste 102, Tempe, Arizona |
| Authorized Official Name and Position | Kiyah Jones (OWNER) |
| Authorized Official Contact | 4809015195 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4939 W Ray Rd Ste 4-231 Chandler AZ 85226-2065 Ph: () - | 4801 S Lakeshore Dr Ste 102 Tempe AZ 85282-7156 Ph: (480) 570-5577 |
| NPI Number | 1730804972 |
|---|---|
| Provider Enumeration Date | 10/10/2022 |
| Last Update Date | 05/03/2023 |
| Certification Date | 05/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730804972 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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