| Mentally Ill Kids In Distress | |
|
810 Gemstone Ave Ste 1&2&3 Bullhead City AZ 86442-6476 | |
| (928) 733-0093 | |
| (928) 636-9904 |
| Full Name | Mentally Ill Kids In Distress |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 810 Gemstone Ave Ste 1&2&3, Bullhead City, Arizona |
| Authorized Official Name and Position | Jeff Kazmierczak (CEO) |
| Authorized Official Contact | 4804144879 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mentally Ill Kids In Distress 7816 N 19th Ave Phoenix AZ 85021-7036 Ph: (480) 414-4879 | Mentally Ill Kids In Distress 810 Gemstone Ave Ste 1&2&3 Bullhead City AZ 86442-6476 Ph: (928) 733-0093 |
| NPI Number | 1770883332 |
|---|---|
| Provider Enumeration Date | 10/29/2010 |
| Last Update Date | 02/11/2025 |
| Certification Date | 02/11/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770883332 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | APPLICATION (Arizona) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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