Organization
SAN CARLOS APACHE WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH MARVIN SIMMONS JR. LPC (CHILD SERVICES CLINICAL COORDINATOR)
(928) 475-4875
Entity
Organization
Contact information
Practice address
5 SAN CARLOS AVE, SAN CARLOS, AZ 85550
(928) 475-4875
Mailing address
5 SAN CARLOS AVE., SAN CARLOS, AZ 85550
(928) 475-4875
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
007411
PA
Other
Enumeration date
10/24/2016
Last updated
10/24/2016
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