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3170 Stillwater Dr. Prescott AZ 86305 | |
| (928) 777-3280 | |
| (928) 717-1660 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 3170 Stillwater Dr., Prescott, Arizona |
| Authorized Official Name and Position | Wendy Razo (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9287773280 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3170 Stillwater Dr. Prescott AZ 86305 Ph: (928) 777-3280 | 3170 Stillwater Dr. Prescott AZ 86305 Ph: (928) 777-3280 |
| NPI Number | 1376601914 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 02/15/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376601914 | NPI | - | NPPES |
| 451604 | Medicaid | AZ | |
| 157612 | Other | AZ | AHCCCS ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | BH-2730 (Arizona) | Secondary |
| 101YM0800X | Counselor - Mental Health | BH-3517 (Arizona) | Primary |
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