Individual
KELLY MEGAHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3011 S SYCAMORE CANYON DRIVE, PARKS, AZ 86018-0304
(928) 853-4152
Mailing address
PO BOX 50304, PARKS, AZ 86018-0304
(928) 853-4152
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
3092313
AZ
Other
Enumeration date
04/24/2014
Last updated
04/24/2014
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