| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1195 S 5th Ave, Yuma, Arizona |
| Authorized Official Name and Position | Cynthia Fullen (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6026949649 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 750 Youngtown AZ 85363-9998 Ph: (602) 694-9649 | 1195 S 5th Ave Yuma AZ 85364-3839 Ph: (602) 694-9649 |
| NPI Number | 1083003677 |
|---|---|
| Provider Enumeration Date | 01/20/2015 |
| Last Update Date | 01/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083003677 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | CSA14ADHS0215 1 (Arizona) | Primary |
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