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2364 Kingman Ave Kingman AZ 86401-4840 | |
| (928) 853-8678 | |
| (602) 712-0235 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2364 Kingman Ave, Kingman, Arizona |
| Authorized Official Name and Position | Douglas K Kramer (CEO) |
| Authorized Official Contact | 6022547328 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2234 N 7th St Phoenix AZ 85006-1651 Ph: (602) 254-7328 | 2364 Kingman Ave Kingman AZ 86401-4840 Ph: (928) 853-8678 |
| NPI Number | 1619366457 |
|---|---|
| Provider Enumeration Date | 01/16/2015 |
| Last Update Date | 01/16/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619366457 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | OTC5949 (Arizona) | Primary |
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