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1113 E Gurley St Prescott AZ 86301-3309 | |
| (928) 583-4878 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1113 E Gurley St, Prescott, Arizona |
| Authorized Official Name and Position | Kevin Ross (CEO) |
| Authorized Official Contact | 9179037445 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 10878 Prescott AZ 86304-0878 Ph: () - | 1113 E Gurley St Prescott AZ 86301-3309 Ph: (928) 583-4878 |
| NPI Number | 1861023905 |
|---|---|
| Provider Enumeration Date | 01/28/2020 |
| Last Update Date | 01/13/2023 |
| Certification Date | 01/13/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861023905 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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