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702 W. Hillside Ave. Prescott AZ 86301 | |
| (928) 778-5907 | |
| (928) 778-5908 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 702 W. Hillside Ave., Prescott, Arizona |
| Authorized Official Name and Position | Carolyn Novicoff (OWNER/CAO) |
| Authorized Official Contact | 9287785907 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
702 W. Hillside Ave. Prescott AZ 86301 Ph: (928) 778-5907 | 702 W. Hillside Ave. Prescott AZ 86301 Ph: (928) 778-5907 |
| NPI Number | 1578826517 |
|---|---|
| Provider Enumeration Date | 06/22/2012 |
| Last Update Date | 02/29/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578826517 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | BH-4029 (Arizona) | Primary |
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