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Organization
COPPER CANYON ACADEMY
Active
Organization
COPPER CANYON ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARIELLA ALLAMAN MA, LAC (THERAPIST)
(928) 567-1322
Entity
Organization
Contact information
Practice address
3095 CORONADO TRAIL, LAKE MONTEZUMA, AZ 86335
(928) 567-1322
Mailing address
PO BOX 230, RIMROCK, AZ 86335-0230
(928) 567-1322
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LAC-13769
AZ BOARD OF BEHAVIORAL HEALTH EXAMINERS
AZ
Enumeration date
05/08/2013
Last updated
05/16/2013
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