Organization
PRACTICAL DEVELOPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLINT RICHARDS (PROGRAM DIRECTOR)
(928) 237-9378
Entity
Organization
Contact information
Practice address
1965 COMMERCE CENTER CIR, SUITE C, PRESCOTT, AZ 86301-4484
(928) 237-9378
(954) 746-8231
Mailing address
1965 COMMERCE CENTER CIR, SUITE C, PRESCOTT, AZ 86301-4484
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
06/29/2015
Last updated
06/29/2015
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