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Lot 165 Blanco Rd Saint Michaels AZ 86511-0645 | |
(928) 871-5409 | |
Not Available |
Full Name | |
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Speciality | Counselor - Professional |
Location | Lot 165 Blanco Rd, Saint Michaels, Arizona |
Authorized Official Name and Position | Leroy Jim (OWNER) |
Authorized Official Contact | 9288715409 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Lot 165 Blanco Road Karigan Estates Saint Michaels AZ 86511-0645 Ph: (928) 871-5409 | Lot 165 Blanco Rd Saint Michaels AZ 86511-0645 Ph: (928) 871-5409 |
NPI Number | 1225403637 |
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Provider Enumeration Date | 12/10/2015 |
Last Update Date | 12/10/2015 |
Identifier | Type | State | Issuer |
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1225403637 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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101YP2500X | Counselor - Professional | 0146941 (New Mexico) | Primary |