Organization
MOGOLLON TREATMENT CENTER
Active
Other names
Mogollon Residential
Organization subpart
Yes
Provider details
NPI number
Authorized official
TYRI NORMAN BLONDAL LMSW (COO)
(602) 516-2414
Entity
Organization
Contact information
Practice address
212 W WADE LN, PAYSON, AZ 85541-4852
(928) 466-4242
(928) 474-7460
Mailing address
306 W AERO DR, PAYSON, AZ 85541-5405
(602) 516-2414
(928) 474-7460
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
01/30/2025
Last updated
01/30/2025
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