| Directly Affected | |
|
2522 S Terripin Mesa AZ 85209-4959 | |
| (614) 980-2116 | |
| Not Available |
| Full Name | Directly Affected |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 2522 S Terripin, Mesa, Arizona |
| Authorized Official Name and Position | Dominique Myrick (PRESIDENT) |
| Authorized Official Contact | 6149802116 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Directly Affected 2522 S Terripin Mesa AZ 85209-4959 Ph: (614) 980-2116 | Directly Affected 2522 S Terripin Mesa AZ 85209-4959 Ph: (614) 980-2116 |
| NPI Number | 1124603394 |
|---|---|
| Provider Enumeration Date | 03/10/2021 |
| Last Update Date | 03/10/2021 |
| Certification Date | 03/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124603394 | NPI | - | NPPES |
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