| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 1444 S 4th Ave, Yuma, Arizona |
| Authorized Official Name and Position | Anthony Joseph Alberta (PRESIDENT) |
| Authorized Official Contact | 6023690075 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3525 E Cochise Dr Phoenix AZ 85028-3924 Ph: (602) 369-0075 | 1444 S 4th Ave Yuma AZ 85364-4604 Ph: (928) 261-8668 |
| NPI Number | 1295804664 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295804664 | NPI | - | NPPES |
| 133535 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | BH2649 (Arizona) | Primary |
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