| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 661 N G Ave, Douglas, Arizona |
| Authorized Official Name and Position | Becca King (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 5204966310 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
877 S Alvernon Way Ste 200 Tucson AZ 85711-5341 Ph: (520) 770-1197 | 661 N G Ave Douglas AZ 85607-2105 Ph: (520) 364-6767 |
| NPI Number | 1407262512 |
|---|---|
| Provider Enumeration Date | 07/09/2014 |
| Last Update Date | 02/05/2025 |
| Certification Date | 02/05/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407262512 | NPI | - | NPPES |
| 003237 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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