Organization
A WILLOWS GRACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL BENNETT LPC (OWNER)
(602) 291-7364
Entity
Organization
Contact information
Practice address
1220 S ALMA SCHOOL RD STE 103, MESA, AZ 85210-2078
(602) 291-7364
Mailing address
PO BOX 40382, MESA, AZ 85274-0382
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
10/02/2021
Last updated
03/30/2022
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